2006-LB: Increased Risk of DKA among Black SGLT2i Users—The Impact of Demographics and Patient Characteristics on DKA Prevalence

Introduction and Objective: Sodium Glucose Cotransporter-2 Inhibitors, or SGLT2is, are an anti-hyperglycemic medication with indications for diabetes, HF and CKD. SGLT2i usage is associated with increased risk for diabetic ketoacidosis (DKA), and we conducted a retrospective analysis for patient quality improvement at our hospital system. Our findings indicate a relationship between demographic identity variables and the likelihood of developing DKA. Methods: Our study focused on adult Northshore Endeavor Health patients who were prescribed SGLT2is from January of 2021 to October 2022 (n=10946). The average age of the population was 65.9 (SD=12.5), the average BMI was 30.7 (SD=6.7), and 2.1% were admitted due to DKA. The population was 40.3% female, 51.3% Caucasian, 14.8% Asian, 7.1% Black, 24.9% identified as “Other” for their race and the race was unknown for 1.7% of the population. 13.2% also identified as Hispanic. Other comorbidities were known: 0.4% had T1D, 27.3% with T2D, 21.3% with CKD, 26.8% CAD, 24.0% with HF, and 17.6% with HTN. A multivariate logistic regression model was used to understand how different variables affect the risk of having DKA in SGLT2i patients. Results: We found an increased risk in developing DKA among SGLT2i patients who are Black (OR=1.54, p=0.048). Additionally, we found an increased risk in developing DKA among SGLT2i patients who have CAD (OR=1.44, p=0.027), T1D (OR=6.46, p<0.001), or T2D (OR=3.29, p<0.001). Analysis revealed a decreased risk in developing DKA among SGLT2i patients who were Asian (OR=0.45, p<0.001), another race not listed (OR=0.67, p=0.042), or non-Hispanic (OR=0.62, p=0.038). Conclusion: Our findings demonstrate that demographic and patient characteristics can result in increases in the likelihood of developing DKA among SGLT2i patients. Black individuals had the highest risk of developing DKA, which could be worsened by underlying diabetes and/or heart disease. Further research should be done to target this vulnerable population. Disclosure E.S. Gross: None.