Diabetic ketoacidosis (DKA) remains a major concern in the management of type 1 diabetes mellitus (T1DM), particularly when considering therapies such as sodium-glucose cotransporter 2 inhibitors (SGLT2i), which are associated with increased DKA risk but may provide kidney protection. Understanding whether reduced kidney function independently affects DKA risk is therefore clinically relevant. Data from the Diabetes Control and Complications Trial and the Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study, published in Diabetes Care, were analyzed to assess whether reduced estimated glomerular filtration rate (eGFR) is associated with higher DKA incidence in T1DM.

The analysis included 1,441 participants followed over 35 years. Time-varying eGFR and the hazard of the first DKA event were assessed using Poisson regression and extended Cox proportional hazards models. The study examined whether declining kidney function was associated with DKA risk independent of SGLT2i use.

During follow-up, 297 participants experienced 488 DKA events. Unadjusted and adjusted analyses showed no statistically significant difference in DKA rates among individuals with eGFR between 30 and 90 mL/min/1.73 m² compared with those with eGFR 90-120 mL/min/1.73 m². The incidence rate in the reference group was 0.65 events per 100 person-years.

These findings indicate that moderately reduced eGFR alone was not associated with increased DKA risk in individuals with T1DM. The results support further evaluation of the potential kidney-protective role of SGLT2i in carefully selected patients.