Clinical features and outcomes of diabetic ketoacidosis in patients using SGLT2 inhibitors: A systematic review and meta-analysis.

AIMS

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are effective antihyperglycaemic agents; however, they also increase the risk of diabetic ketoacidosis (DKA). As the clinical evidence comparing DKA features between SGLT2i users and non-users remains limited due to the low incidence of DKA, this study aimed to compare the clinical features and outcomes of DKA in SGLT2i users and non-users by conducting a systematic review and meta-analysis.

MATERIALS AND METHODS

Relevant studies were searched in PubMed, Scopus, and Web of Science in February 2025. Studies that compared the clinical features or outcomes of DKA between SGLT2i users and non-users were included. Pooled estimates were derived using odds ratios for binary variables and mean differences for continuous variables.

RESULTS

A total of 9 studies were analysed. DKA cases in SGLT2i users had lower odds of prior DKA and insulin use. Compared with DKA cases in non-users, SGLT2i users had lower glucose, HbA1c, creatinine, and lactate levels. No significant differences were found in the length of hospitalisation, intensive care unit admission, or in-hospital mortality.

CONCLUSIONS

These findings provide quantitative evidence of the distinct clinical features of SGLT2i-associated DKA, which may aid in early detection, management, and prevention in clinical practice.