Low eGFR Rates Not Linked to Higher DKA Risk in Type 1 Diabetes

New study supports use of kidney-protective meds for patients with type 1 diabetes

Published on Feb. 12, 2026

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A new study found that levels of kidney function alone had no apparent impact on the risk for diabetic ketoacidosis (DKA) among adults with type 1 diabetes, regardless of the use of kidney protective medication. The researchers analyzed 35 years of data from the DCCT/EDIC study and concluded that the lack of increased DKA risk for individuals with type 1 diabetes and reduced eGFR supports the design of clinical trials of SGLT inhibitors in this patient population to identify kidney-protective benefits.

Why it matters

In people with type 2 diabetes, SGLT inhibitors have been shown to reduce late-stage kidney outcomes, but they also increase DKA risk. However, these kidney-protective medications are not routinely approved for type 1 diabetes, and the impact of reduced kidney function on DKA risk in this population remains unclear. This study aims to inform the design and risk-stratification of trials evaluating SGLT inhibitors for kidney protection in type 1 diabetes.

The details

The researchers analyzed 35 years of data from the DCCT/EDIC study, which included 1,441 adults with type 1 diabetes. During the 34-year follow-up, 297 participants experienced at least one DKA event, with a total of 488 DKA events. In both unadjusted and adjusted analyses, the researchers found no statistically significant difference in DKA rates among individuals with an eGFR between 30 and 90 mL/min/1.73 m2 compared to those with an eGFR between 90 and 120 mL/min/1.73 m2. The researchers acknowledged that their findings contrast with a previous study, the FinnDiane study, which reported higher DKA risk among individuals with baseline end-stage kidney disease and in those with baseline eGFR ≤ 60 mL/min/1.73 m2.

  • The study analyzed 35 years of data from the DCCT/EDIC study.

The players

Abdulmohsen Bakhsh

An endocrinologist at Mount Sinai Hospital, Toronto, Canada, and the lead author of the study.

Charles Leonard

An associate professor at the Perelman School of Medicine, University of Pennsylvania, in Philadelphia, who was not involved in the study but provided commentary.

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What they’re saying

“I was not surprised, given the cohort's characteristics and the small number of events in the lower eGFR strata, which limits the ability to detect modest effects.”

— Abdulmohsen Bakhsh, Endocrinologist (Medscape Medical News)

“Distinguishing causation from correlation is critical before concluding that low eGFR is a risk‑enhancing state.”

— Charles Leonard, Associate Professor (Medscape Medical News)

“Given limited precision at very low eGFR and the study's potentially misplaced emphasis on statistical significance, I see this as less than convincing evidence at present.”

— Charles Leonard, Associate Professor (Medscape Medical News)

What’s next

Ongoing SGLT inhibitor trials in type 1 diabetes and emerging tools like continuous ketone monitors may enable safer, targeted use in selected patients. Future studies should prospectively assess DKA risk in patients with established chronic kidney disease, use central adjudication/ketone data, identify benefit subgroups, and test implementation strategies such as education and ketone monitoring to mitigate DKA risk.

The takeaway

This study suggests that reduced kidney function alone does not confer higher DKA risk in type 1 diabetes, supporting the design of clinical trials to evaluate the kidney-protective benefits of SGLT inhibitors in this patient population. However, further research is needed to better define the kidney-benefit versus DKA-risk balance, especially in advanced kidney disease.