Diabetes Forecast

SGLT2 Inhibitors and DKA in People With Type 1 Diabetes

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What to Know

Treating type 1 diabetes with insulin alone can be a challenge. One fairly new class of drugs, SGLT2 inhibitors, appears to be an effective add-on treatment. It reduces blood glucose levels, body weight, and the amount of insulin patients need. Also, it does not increase the frequency of hypoglycemia (low blood glucose levels) in people with either type 1 or type 2 diabetes. However, the drug may increase the risk of diabetic ketoacidosis (DKA), a dangerous form of extreme hyperglycemia (high blood glucose levels) that can lead to coma or even death. How real is that risk?

The Study

A total 351 people with poorly controlled type 1 diabetes signed up for the study. All either took multiple daily injections of insulin or used an insulin pump, which continuously delivers insulin under the skin. The participants were randomly assigned to one of two groups for the 18-week study. One group took the study drug canagliflozin, an SGLT2 inhibitor, at 100 or 300 mg once a day. The other group was given a placebo, which resembled the treatment pill but had no active ingredients. The goal: to determine which group had a higher number of participants who experienced DKA.

The Results

Canagliflozin, an SGLT2 inhibitor, appears to boost the risk of serious DKA, at least when taken at the higher dose. However, the patients monitored themselves for ketones throughout the study. That means it is possible that some of them made mistakes, which could have affected the results of the study.


If you take canagliflozin, be aware of the potential risks and know how to monitor yourself for any changes in your ketone levels. Talk to your doctor about these concerns and be aware of the symptoms of DKA and the circumstances in which it is most likely to occur.

Diabetic Ketoacidosis With Canagliflozin, a Sodium–Glucose Cotransporter 2 Inhibitor, in Patients With Type 1 Diabetes. Anne L. Peters, Robert R. Henry, Payal Thakkar, Cindy Tong, Maria Alba. Diabetes Care Apr 2016, 39 (4) 532-538; http://dx.doi.org/10.2337/dc15-1995

The information on this screen does not take the place of care from your doctor or other health care provider. If you have general questions about diabetes or diabetes-related research, e-mail askada@diabetes.org or call 1-800-DIABETES (800-342-2382).



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