# Balancing Risks and Benefits: Sodium-Glucose Cotransporter 2 Inhibitors and the Risk of Diabetic Ketoacidosis

## TL;DR

This paper discusses the benefits and risks of SGLT2 inhibitors, focusing on their association with diabetic ketoacidosis in diabetes management.

## Contribution

The paper highlights the risk factors for SGLT2i-associated DKA and emphasizes the importance of awareness among patients and healthcare providers.

## Key findings

- SGLT2 inhibitors are effective in managing diabetes and cardiovascular risks but can cause DKA.
- Risk factors for DKA include insulin dose reduction, low carbohydrate diets, alcohol, and surgery.
- Patients with type 1 diabetes are at higher risk for SGLT2i-associated DKA.

## Abstract

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a new class of drugs that have been proven beneficial in the management of diabetes, chronic kidney disease, and heart failure and in the mitigation of cardiovascular risk. The benefits of SGLT2i therapy have led to the rapid adoption of these drugs in clinical guidelines. Since the introduction of these drugs, concerns have arisen, as diabetic ketoacidosis (DKA) unexpectedly occurred in patients treated with SGLT2i. DKA is an infrequent but serious complication of SGLT2i therapy, and is potentially preventable. The risk factors for the development of SGLT2i-associated DKA are inappropriate dose reductions of insulin, the dietary restriction of carbohydrates, and factors that may increase insulin demand such as excessive alcohol intake and major surgery. Moreover, the risk of SGLT2i-associated DKA is higher in persons with type 1 diabetes. It is crucial that both patients and healthcare providers are aware of the risks of SGLT2i-associated DKA. In an effort to encourage safe prescribing of this effective class of drugs, we present two cases that illustrate the risks of SGLT2i therapy with regard to the development of DKA.