Predisposing Factors of Ketoacidosis in Type 2 Diabetes Patients Using Sodium-Glucose Co-Transporter 2 Inhibitors: A Multicenter Case-Control Study
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Abstract
This retrospective, multicenter case-control study is designed to investigate type 2 diabetes mellitus (T2DM) patients treated with sodium-glucose co-transporter-2 (SGLT-2) inhibitors at King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, and Rajavithi Hospital between October 1, 2014, and April 30, 2024. The aims were to identify predisposing factors associated with the occurrence of diabetic ketoacidosis (DKA) in Thai T2DM patients receiving SGLT-2 inhibitors and to analyze the type and severity of DKA episodes. Descriptive statistics were employed to analyze general data, while univariate and multivariate logistic regression analyses were conducted to assess predisposing factors. Group comparisons were performed using the Chi-square test, Fisher's exact test, independent t-test, and Mann-Whitney U test. Statistical significance was set at p < .05.
The study population consisted of 310 patients, divided into a study group comprising 62 patients who experienced DKA (prevalence rate: 1.37% during the study period) and a control group comprising 248 patients who did not develop DKA. Statistically significant predisposing factors for DKA included infection (Adjusted OR = 28.31, p < .001), recent insulin dosage reduction within the last month (Adjusted OR = 5.58, p < .001), and a history of DKA within the past year (Adjusted OR = 8.76, p = .038). Among DKA cases, the proportion of hyperglycemic diabetic ketoacidosis (HDKA) (54.84%) exceeded that of euglycemic diabetic ketoacidosis (EuDKA) (45.16%). Most DKA cases were of mild severity (46.77%), followed by moderate (27.42%) and severe cases (25.81%). The findings revealed that infection, recent insulin dosage reduction within the last month, and a history of DKA within the past year in T2DM patients treated with SGLT-2 inhibitors are predisposing factors to DKA. To reduce the risk of DKA and enhance the safety of SGLT-2 inhibitor therapy, targeted counseling regarding medication management during illness, close monitoring of their condition, and tailored therapeutic adjustments are recommended.
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