Ketoacidosis at Hypoglycemic and Low Glucose Levels Associated with SGLT2 Inhibitor Use: A Descriptive Systematic Review of Published Cases

Background/Objectives: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are increasingly used for heart failure and chronic kidney disease beyond type 2 diabetes, increasing exposure among people without diabetes. Ketoacidosis is a recognized complication, but presentations at low blood glucose (<100 mg/dL) fall outside the familiar euglycemic diabetic ketoacidosis (DKA) alert and are easily missed. We aimed to describe the clinical phenotype of such cases; this review was not registered.