The edition · Diabetes & Endocrinology
SGLT2 ketoacidosis risk lasts the whole course, not the first month
A 282,000-patient Scandinavian register study finds ketoacidosis on SGLT2 inhibitors clusters in identifiable patients and persists throughout treatment. Also: the 2026 ADA/EASD type 1 consensus, supervised exercise in pregnancy, glargine versus NPH in low-resource settings, and a Baxter insulin infusion recall.
The edition in brief
Ketoacidosis on SGLT2 inhibitors ran at 2.43 per 1000 person-years across 322,597 treatment episodes in Sweden, Denmark and Norway. Risk was highest soon after starting but did not disappear. The strongest associations were HbA1c of 83 mmol/mol or more (OR 15.4), malnutrition (OR 10.5), previous ketoacidosis (OR 10.4), BMI under 20 (OR 10.0) and recent hypoglycaemia (OR 5.2); infection preceded almost a third of events. The practical message is that sick-day counselling is a standing instruction, not a first-prescription one. The ADA and EASD have updated their 2021 consensus on type 1 diabetes in adults, with more weight on technology, interventions to delay stage 3 disease, complication screening, obesity and cardiovascular risk. A meta-analysis of 19 trials found supervised exercise in pregnancy lowered gestational diabetes risk (RR 0.74) and gestational hypertension (RR 0.55), with larger effects when started early. HumAn-1, in Bangladesh and Tanzania, found glargine no better than human isophane insulin for time in very low range or time in range in young people with type 1 diabetes. FDA lists a Class II recall of Baxter's Myxredlin premixed insulin infusion for manufacturing-practice deviations.
ADA and EASD update the adult type 1 diabetes consensus
Treat weight and cardiovascular risk as part of adult type 1 care, and read the full consensus before revising local protocols.
Supervised exercise in pregnancy lowers gestational diabetes risk
Offer high-risk pregnant women a supervised, combined aerobic and resistance programme from early pregnancy.
Glargine no better than human insulin in low-resource type 1 care
In resource-limited type 1 care, spend first on monitoring, education and supply rather than on switching basal insulin.
FDA Class II recall: Baxter Myxredlin insulin infusion
Hospitals using premixed Myxredlin should check stock against the FDA recall listing and keep a compounded infusion protocol ready.
Five questions before an SGLT2 inhibitor refill
Repeat SGLT2 sick-day rules at every refill for patients with any of the five high-risk features.
SGLT2 ketoacidosis persists beyond the first months of treatment
Give every patient on an SGLT2 inhibitor a written sick-day plan and reassess ketoacidosis risk at each review.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for diabetes & endocrinology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free