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Retrospective cohort study on absolute risks of diabetic ketoacidosis

Retrospective cohort study on absolute risks of diabetic ketoacidosis

Retrospective cohort study using patient records data from Canada and the UK between 2013 and 2018 compared the incidences of diabetic ketoacidosis in type 2 diabetes patients receiving SGLT2 (sodium glucose co-transporter 2) inhibitors vs. DPP4 (dipeptidyl peptidase 4) inhibitors.

Each of the 208,757 adult T2DM patients initiating an SGLT2 inhibitor was matched to a recipient of a DPP4 inhibitor (164,032 unique DPP4 inhibitor recipients owing to matching with replacement) using timeconditional propensity scores to form the two study cohorts.

Each participating site conducted the analyses (including descriptive analyses and Cox proportional hazards models) independently according to a common analytical protocol. Results from each site were further pooled by using random-effects models. Additional secondary analyses were performed stratifying by molecule, patient characteristics etc. as well as sensitivity analyses.

During a total of 370,454 person-years of follow-up, 521 patients were hospitalised with diabetic ketoacidosis, representing an overall incident rate of 1.41 per 1,000 person-years; with a higher incident rate in the SGLT2 vs. DPP4 exposure groups (2.03 vs. 0.75 per 1,000 person-years). Higher incidence rates were observed in all 3 available SGLT2 molecules suggesting a class effect that SGLT2 inhibitors are associated with higher risks for diabetic ketoacidosis compared with DPP4 inhibitors.

This study gives us the best estimate for the absolute risk of diabetic ketoacidosis to help us counsel our patients. The absolute risk is relatively small with an excess crude rate of 1.2 per 1000 patient years.

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Editorial Board

Image
Dr. Salvatore A. De Cosmo's image

Dr. Salvatore A. De Cosmo

Head of Unit of Internal Medicine and Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza” San Giovanni, Rotondo, Italy
,
Image
Dr. Juan José Gorgojo Martínez's image

Dr. Juan José Gorgojo Martínez

Head of Department of Endocrinology and Nutrition, University Hospital Fundación, Alcorcon, Madrid, Spain
,
Image
Dr. Patrick Holmes' image

Dr. Patrick Holmes

General Practitioner, St. George's Medical Practice, Darlington, UK

Editorial Board

Image
Dr. Salvatore A. De Cosmo's image

Dr. Salvatore A. De Cosmo

Head of Unit of Internal Medicine and Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza” San Giovanni, Rotondo, Italy
Image
Dr. Juan José Gorgojo Martínez's image

Dr. Juan José Gorgojo Martínez

Head of Department of Endocrinology and Nutrition, University Hospital Fundación, Alcorcon, Madrid, Spain
Image
Dr. Patrick Holmes' image

Dr. Patrick Holmes

General Practitioner, St. George's Medical Practice, Darlington, UK

Publication under Spotlight

Sodium-Glucose Cotransporter-2 Inhibitors and the Risk for Diabetic Ketoacidosis. A Multicenter Cohort Study

 

Ann Intern Med

2020;173(6):417-425

 

Authors: Antonios Douros, Lisa M Lix, Michael Fralick, Sophie Dell’Aniello, Baiju R Shah, Paul E Ronksley, Eric Tremblay, Nianping Hu, Silvia Alessi-Severini, Anat Fisher, Shawn C Bugden, Pierre Ernst and Kristian B Filion

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