Elevated ?-hydroxybutyric acid with no ketoacidosis in type 2 diabetic patients using sodium-glucose cotransporter-2 inhibitors

SGLT2 inhibitor (SGLT2i) class of medications are known to cause to euglycemic diabetic ketoacidosis (euDKA) as reported in the article by Lin et al. in your esteemed publication about this entity being reported for the first time in Taiwanese population.1 We wish to share the findings from our center to further expand the spectrum of findings associated with SGLT2i therapy. SGLT2i treatment in patients with preexisting atherosclerotic heart disease and those with high risk of cardiovascular events is associated with a reduction in cardiovascular (CV) mortality, heart failure hospitalizations, and death from any cause.