What is the clinical evidence from this study?

Study design: Observational. Population: Diabetic ketoacidosis (n=191). Intervention: SGLT2 inhibitors vs. Non-users. Primary outcome: Severe DKA (p=0.007).

What does this research mean for the field?

SGLT2 inhibitor use is independently associated with more severe diabetic ketoacidosis and a lower nadir pH among hospitalized patients with diabetes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether baseline use of sodium glucose cotransporter 2 inhibitors affects the clinical and biochemical severity of diabetic ketoacidosis in hospitalized patients.

September 1, 2026Diabetes/Metabolism Research and ReviewsOpen Access

Clinical Severity of Diabetic Ketoacidosis by SGLT2 Inhibitors Use: A Retrospective Observational Study

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Key result

Baseline SGLT2i use is linked to a ~143% higher rate of severe DKA versus non-users.

P=0.007
n=191

Why the study?

SGLT2 inhibitors have established cardiac and kidney benefits, but diabetic ketoacidosis is a rare complication associated with their use that entails significant morbidity and mortality.

Does SGLT2 inhibitor use increase the clinical severity of diabetic ketoacidosis in patients with diabetes?

Population

191 patients with diabetes admitted with DKA to a large tertiary hospital

Comparison

Baseline SGLT2i use vs non-use

Design

Retrospective observational study

Authors

MNMor NaamanHebrew University of Jerusalem TFTamar Fisher-NegevHebrew University of Jerusalem GAGenya Aharon‐HananelTel Aviv University

Discussion

Member takes

Implication

Heightened DKA vigilance remains essential with SGLT2i; this Level 3 cohort leaves open causal links and prevention strategies.

Key Points

To determine whether baseline use of sodium glucose cotransporter 2 inhibitors affects the clinical and biochemical severity of diabetic ketoacidosis in hospitalized patients.
Retrospective observational study of N=191 patients with diabetes admitted with diabetic ketoacidosis to a large tertiary hospital.
Extracted demographic, clinical, and laboratory parameters from electronic medical records to compare SGLT2 inhibitor users (n=27) with non-users (n=164).
Evaluated primary outcomes including nadir pH, frequency of severe diabetic ketoacidosis, intensive care unit admission rates, length of hospital stay, and inpatient mortality.
SGLT2 inhibitor users had significantly lower nadir pH (7.08 ± 0.15 vs. 7.15 ± 0.12, p = 0.006) and a higher proportion of severe DKA (29.6% vs. 12.2%, p = 0.007), an association that remained independent after multivariable adjustment.
Composite incidence of mortality and/or ICU admission was 74.1% in SGLT2 inhibitor users versus 72.0% in non-users (p = 0.819), with inpatient mortality occurring in 3/27 users versus 3/164 non-users.
Length of hospital stay and ICU admission requirements did not significantly differ between groups, with consistent biochemical findings observed after excluding patients with new-onset diabetes.

Study Design

Type

Observational (n=191)

Multicenter

Structured PICO

Does SGLT2 inhibitor use increase the clinical severity of diabetic ketoacidosis in patients with diabetes?

Population

191 patients with diabetes admitted with DKA to a large tertiary hospital.

Exposure

Sodium glucose cotransporter 2 inhibitors (SGLT2i)

Comparator

Non-use of SGLT2 inhibitors

Outcome

DKA severity as determined by nadir pHsafety

Main Result

Absolute Event Rate: 29.6% vs 12.2%

p-value: p=0.007

Among patients hospitalized with diabetic ketoacidosis, prior use of SGLT2 inhibitors is associated with a more severe biochemical presentation, though ICU admission and hospital stay duration appear similar to non-users.

Limitations

The observed difference in inpatient mortality was based on few events and should be interpreted cautiously.
Retrospective observational design
Few inpatient mortality events, limiting interpretation of mortality differences

Cite This Study

Naaman et al. (2026) conducted an observational in Diabetic ketoacidosis (n=191). SGLT2 inhibitors vs. Non-users was evaluated on Severe DKA (p=0.007). Baseline SGLT2 inhibitor use in patients hospitalized with DKA was associated with a higher rate of severe DKA (29.6% vs. 12.2%, p=0.007) and lower nadir pH compared to non-users.

synapsesocial.com/papers/6aa76fed23d56a6967038c03 https://doi.org/10.1002/dmrr.70226

Topics

SGLT2 inhibitors in heart failure

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September 1, 2026Diabetes/Metabolism Research and ReviewsOpen Access

Clinical Severity of Diabetic Ketoacidosis by SGLT2 Inhibitors Use: A Retrospective Observational Study

View Full Paper

Ask AI

Bookmark

Key result

Baseline SGLT2i use is linked to a ~143% higher rate of severe DKA versus non-users.

P=0.007
n=191

Why the study?

SGLT2 inhibitors have established cardiac and kidney benefits, but diabetic ketoacidosis is a rare complication associated with their use that entails significant morbidity and mortality.

Does SGLT2 inhibitor use increase the clinical severity of diabetic ketoacidosis in patients with diabetes?

Population

191 patients with diabetes admitted with DKA to a large tertiary hospital

Comparison

Baseline SGLT2i use vs non-use

Design

Retrospective observational study

Authors

MNMor NaamanHebrew University of Jerusalem TFTamar Fisher-NegevHebrew University of Jerusalem GAGenya Aharon‐HananelTel Aviv University

Discussion

Member takes

Implication

Heightened DKA vigilance remains essential with SGLT2i; this Level 3 cohort leaves open causal links and prevention strategies.

Key Points

To determine whether baseline use of sodium glucose cotransporter 2 inhibitors affects the clinical and biochemical severity of diabetic ketoacidosis in hospitalized patients.
Retrospective observational study of N=191 patients with diabetes admitted with diabetic ketoacidosis to a large tertiary hospital.
Extracted demographic, clinical, and laboratory parameters from electronic medical records to compare SGLT2 inhibitor users (n=27) with non-users (n=164).
Evaluated primary outcomes including nadir pH, frequency of severe diabetic ketoacidosis, intensive care unit admission rates, length of hospital stay, and inpatient mortality.
SGLT2 inhibitor users had significantly lower nadir pH (7.08 ± 0.15 vs. 7.15 ± 0.12, p = 0.006) and a higher proportion of severe DKA (29.6% vs. 12.2%, p = 0.007), an association that remained independent after multivariable adjustment.
Composite incidence of mortality and/or ICU admission was 74.1% in SGLT2 inhibitor users versus 72.0% in non-users (p = 0.819), with inpatient mortality occurring in 3/27 users versus 3/164 non-users.
Length of hospital stay and ICU admission requirements did not significantly differ between groups, with consistent biochemical findings observed after excluding patients with new-onset diabetes.

Study Design

Type

Observational (n=191)

Multicenter

Structured PICO

Does SGLT2 inhibitor use increase the clinical severity of diabetic ketoacidosis in patients with diabetes?

Population

191 patients with diabetes admitted with DKA to a large tertiary hospital.

Exposure

Sodium glucose cotransporter 2 inhibitors (SGLT2i)

Comparator

Non-use of SGLT2 inhibitors

Outcome

DKA severity as determined by nadir pHsafety

Main Result

Absolute Event Rate: 29.6% vs 12.2%

p-value: p=0.007

Limitations

The observed difference in inpatient mortality was based on few events and should be interpreted cautiously.
Retrospective observational design
Few inpatient mortality events, limiting interpretation of mortality differences

Cite This Study

synapsesocial.com/papers/6aa76fed23d56a6967038c03 https://doi.org/10.1002/dmrr.70226

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

Topics

SGLT2 inhibitors in heart failure

View Full Paper

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