SGLT2 inhibitor ketoacidosis risk does not fade after the first months

The edition in brief

In 322,597 SGLT2 inhibitor treatment episodes across Sweden, Denmark and Norway, ketoacidosis occurred at 2.43 per 1000 person-years. Risk was highest soon after starting but persisted throughout follow-up. Very high HbA1c, malnutrition, previous ketoacidosis, low BMI and recent hypoglycaemia were the strongest risk factors, and infection was the commonest precipitant. The ADA and EASD have published their updated 2026 consensus on type 1 diabetes in adults, with more weight on technology, disease-delaying therapy, obesity and cardiovascular risk. Long-term Diabetes Prevention Program follow-up associated the lifestyle arm, but not metformin, with less multimorbidity (HR 0.79). The FDA lists a Class II recall of Baxter's Myxredlin premixed intravenous insulin for manufacturing-practice deviations. In the HumAn-1 trial in Bangladesh and Tanzania, glargine did not improve time in range or time in very low range over human isophane or premixed insulin in 400 young people with type 1 diabetes. Today's pearl: sick-day rules for SGLT2 inhibitors need repeating at every review, not just at the first prescription.