A. Bakhsh, A. Saleemi, D. Budhram, Y. Zhang, P. Bapat, MI. Abuabat, NJ. Verhoeff, D. Mumford, A. Orszag, M. Fralick, A. Weisman, W. Cheema, MR. Waniss, JP. Ouimet, G. Tomlinson, DZI. Cherney, LE. Lovblom, et al. (2026). Chronic Kidney Disease and Risk of Diabetic Ketoacidosis in Type 1 Diabetes. Diabetes care, 49(3), 478-482. https://doi.org/10.2337/dc25-1955

PubMed 41591367

[Abstract]
OBJECTIVE: Sodium-glucose cotransporter inhibitors (SGLTi) in type 1 diabetes increase diabetic ketoacidosis (DKA) risk but may offer kidney protection. This study assesses whether a reduced estimated glomerular filtration rate (eGFR) increases DKA risk even without SGLTi.

RESEARCH DESIGN AND METHODS: Time-varying eGFR and hazard of first DKA event were analyzed from 35-year data in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study using Poisson and extended Cox proportional hazards models.

RESULTS: Of 1,441 participants, 297 experienced 488 DKA events. Unadjusted and adjusted DKA rates in individuals with eGFR between 30 and 90 mL/min/1.73 m2 showed no statistical difference compared with those with eGFR 90-120 mL/min/1.73 m2 (incidence rate of 0.65 events per 100 person-years).

CONCLUSIONS: A reduced eGFR (between 30 and 90 mL/min/1.73 m2) alone was not associated with increased DKA risk. This finding supports further research into potential kidney-protection benefits of SGLTi for selected individuals with type 1 diabetes.