Chronic Kidney Disease and Risk of Diabetic Ketoacidosis in Type 1 Diabetes

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.