Effect of Sodium–Glucose Cotransporter 2 Inhibitors on Diabetic Ketoacidosis Among Patients With Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials

Sodium–glucose cotransporter 2 (SGLT2) inhibitors are a novel class of antidiabetes drugs for the treatment of type 2 diabetes (T2D) (1). In addition to their hypoglycemic effect, SGLT2 inhibitors also offer several beneficial effects, such as weight loss and blood pressure reduction (1). However, the overall health benefits of these drugs needed to outweigh their possible side effects. Recently, cumulative evidence suggests that SGLT2 inhibitors may lead to diabetic ketoacidosis (DKA), which is a serious acute complication of diabetes (2,3). In May 2015, the U.S. Food and Drug Administration issued an updated drug safety communication warning about SGLT2 inhibitors potentially increasing the risk of DKA (4). As DKA is a rare adverse effect, the evidence from individual studies or simply pooling the numbers from multiple reports is generally weak. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) …