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

Objective: Sodium glucose-linked transporter inhibitors (SGLTi) in type 1 diabetes increase diabetic ketoacidosis (DKA) risk but may offer kidney protection. This study assesses whether 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 1441 participants, 297 experienced 488 DKA events. Unadjusted and adjusted DKA rates in individuals with eGFR between 30-90 ml/min/1.73 m² showed no statistical difference compared to those with eGFR 90-120ml/min/1.73m2 (incidence rate of 0.65 events per 100 person-years). Conclusions: Reduced eGFR (between 30-90 ml/min/1.73 m²) alone was not associated with increased DKA risk. This finding supports further research into potential kidney-protection benefits of sodium glucose-linked transporter inhibitors for selected individuals with type 1 diabetes.