Evolving Clinical Features of Diabetic Ketoacidosis: The Impact of SGLT2 Inhibitors

<b>Background/Objectives</b>: The antidiabetic effect of SGLT2 inhibitors (SGLT2-is) is based on their ability to increase glucose excretion through urine by inhibiting the kidney-resident SGLT2 protein. Euglycemic diabetic ketoacidosis (EuDKA) is an uncommon but potentially life-threatening adverse effect of these medications, which are notable for their antidiabetic, cardiovascular, and renal protective properties. This study aimed to clarify the impact of SGLT2-is on demographic, clinical, and biochemical characteristics in patients with DKA. <b>Methods</b>: A total of 51 individuals with a diagnosis of DKA were included in the trial; 19 of these patients were treated with SGLT2-is, while 32 were not. Patients diagnosed with DKA and treated with SGLT2-is were compared to those not treated with the medication in terms of clinical, biochemical, and laboratory characteristics. <b>Results</b>: The age of patients utilizing SGLT2-is was statistically considerably greater than that of non-users (<i>p</i> < 0.001). EuDKA was exclusively noted in the SGLT2-is cohort (<i>p</i> = 0.005). Urinary tract infections, vulvovaginitis, and genitourinary infections were substantially more prevalent among SGLT2-i users compared with non-users among both women and the overall patient group (<i>p</i> = 0.036, <i>p</i> = 0.001, <i>p</i> = 0.005, <i>p</i> = 0.003, respectively). Plasma glucose concentrations were significantly higher in SGLT2-i non-users (<i>p</i> = 0.006). Chloride (Cl^-) concentrations were elevated among SGLT2-i users (<i>p</i> = 0.036). <b>Conclusions</b>: The study findings indicate that SGLT2 inhibitors may substantially influence age, serum chloride, EuDKA, and the occurrence of genitourinary infections in individuals with DKA.