A multicenter cohort study conducted in Canada has compared the risk for diabetic ketoacidosis (DKA) associated with sodium-glucose cotransporter-2 (SGLT-2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors. Patients with type 2 diabetes were included in the study, where 208,757 new users of SGLT-2 inhibitors were propensity-score matched with 208,757 users of DPP-4 inhibitors. During the follow-up period of 370,454 person-years, 521 patients were diagnosed with DKA (incidence rate per 1,000 person-years: 1.40 [95% CI: 1.29-1.53]). SGLT-2 inhibitors were associated with a higher risk for DKA in comparison to DPP-4 inhibitors (incidence rate: 2.03 [1.83-2.25] vs. 0.75 [0.63-0.89], hazard ratio: 2.85 [1.99-4.08]). Individual drug hazard ratios for dapagliflozin, empagliflozin and canagliflozin were 1.86, 2.52 and 3.58, respectively. The results confirm a significantly increased and molecule-specific risk for DKA associated with SGLT-2 inhibitors in patients with type 2 diabetes. The original research can be viewed here.

Contributed by Isabella Singh, Australian Medication Safety Services Associate.