Background: SGLT-2 inhibitors (SGLT2i) have cardiovascular and renal benefits but pose an increased risk of DKA. The risk factors for developing DKA while on SLGT2i therapy have not been fully characterized.

Methods: A retrospective, observational chart review was performed to include patients admitted to Houston Methodist in 20with DKA and SGLT2i use. DKA was confirmed using standard laboratories. Potential causes of DKA were categorized based on prior published associations.

Results: Among the 61 patients with DKA, SGLT2i therapy was used at home but discontinued on admission in 46 (75%) , initiated during the hospitalization in 6 (10%) , and continued throughout the hospitalization in 9 (15%) . Potential causes of DKA were infections in 23 (38%) patients, gastrointestinal etiologies in 21 (34%) , NPO and/or perioperative status in 4 (7%) , acute cardiovascular events in 3 (5%) , and (16%) patients had no identifiable etiology.

Conclusions: Among hospitalized patients with DKA and SGLT2i use, we observed poorly controlled diabetes mellitus, with infection and GI disease being the most common associations. This description could help inform strategies to guide safe use of SGLT2i therapy.


S.Williamson: None. M.B.Taha: None. T.R.Brown: None. S.Hebert: None. K.Patel: None. V.J.Narcisse, iii: None. A.R.Sadhu: Advisory Panel; Abbott Diagnostics.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at