A team of researchers from Canada have conducted a population based cohort study to asses whether sodium-glucose cotransporter-2 (SGLT-2) inhibitors increase the risk for diabetic ketoacidosis (DKA) for patients with type 2 diabetes, compared with dipeptidyl peptidase-4 (DPP-4) inhibitors. The study involved 208,757 new users of SGLT-2 inhibitors between 2013 and 2018, who were propensity score-matched with 208,575 new users of DPP-4 inhibitors. During the follow-up period of 370,454 person-years, 521 participants were diagnosed with DKA (incidence rate per 1000 person-years = 1.40 [95% CI = 1.29-1.53]). SGLT-2 inhibitors were linked to an increased risk for DKA (incidence rate = 2.03 [1.83 – 2.25]), compared with DPP-4 inhibitors (incidence rate = 0.75 [0.63 – 0.89]). The overall hazard ratio was 2.85 [1.99 – 4.08]. Hazard ratios for dapagliflozin, empagliflozin and canagliflozin were 1.86 [1.11 – 3.10], 2.52 [1.23 – 5.14] and 3.58 [2.13 – 6.03], respectively. A reduced risk for DKA was associated with previous insulin use, however the association was not influenced by age or sex. It was concluded that SGLT-2 inhibitors were associated with a significantly increased risk for DKA among this population and that these results may exhibit a class effect. The original research, published in the Annals of Internal Medicine, can be found here.