Revisiting the benefits vs risk profile of sodium-glucose co-transporter inhibitor use in type 1 diabetes. Part B: Risks of sodium-glucose co-transporter inhibitor use in type 1 diabetes and ketoacidosis risk mitigation strategies

Sodium-glucose co-transporter (SGLT) inhibitors have been evaluated for use in people with type 1 diabetes (T1D). Despite evidence for glycaemic and non-glycaemic benefits in people with T1D as discussed in the accompanying review (Part A), the increased risk of diabetic ketoacidosis (DKA) with this class of medication remains a barrier limiting its widespread use in this population. DKA is a serious and life-threatening complication of diabetes and the excess risk associated with SGLT inhibitor use needs to be addressed before this medication could be considered as part of glycaemia and complications management in people with T1D. Understanding factors that increase DKA risk in the setting of SGLT inhibitors, as well as an appreciation of general DKA risk factors, may facilitate the development of strategies that allow for an acceptable risk versus benefit ratio to permit the use of SGLT inhibitors in people with T1D.