406-P: Kidney Disease and Risk of Diabetic Ketoacidosis in Type 1 Diabetes
Bibliographic record
Abstract
Introduction & Objective: Sodium glucose linked transporter inhibitors (SGLTi) in T1D raise DKA risk but hold potential for kidney protection, especially with impaired renal function [eGFR <60 ml/min/1.73m2]. We aimed to determine if those with eGFR impairment have higher DKA risk, perhaps owing to lower buffering capacity, thereby reducing safety of SGLTi use. Methods: Previously collected data from the DCCT/EDIC Study was obtained through the NIDDK central repository. We assessedtime-varying eGFR over 34 years as exposures and subsequent time-to-first DKA event as the outcome in Cox proportional hazard models. Results: Of 1441 participants, 297 experienced 488 DKA events over 34-year follow-up. Unadjusted nonlinear association between eGFR categories indicated a “J-shaped” relationship (Figure). Using eGFR of 100 ml/min/1.73m2 as the reference, there were no differences in the relative hazard for eGFR ≤ 110 ml/min/1.73m2 while eGFR > 110 ml/min/1.73m2 had progressively higher risk of DKA. This relationship was only partially explained by covariates in an adjusted model. Conclusion: Impaired kidney function did not increase DKA risk, implying that use of interventions that increase DKA risk (such as SGLTi) should not cause greater concern than in those with normal eGFR. However, hyperfiltration (eGFR ≈ >120ml ml/min/1.73m2) may impart greater DKA risk and requires further study. Disclosure A.M.K. Bakhsh: None. D.R. Budhram: None. P. Bapat: None. M.I. Abuabat: None. N. Verhoeff: None. D. Mumford: None. A. Orszag: None. D. Cherney: Other Relationship; from Boehringer Ingelheim-Lilly, Merck, AstraZeneca, Sanofi, Mitsubishi-Tanabe, Abbvie, Janssen, Bayer, Prometic, BMS, Maze, Gilead, CSL-Behring, Otsuka, Novartis, Youngene, Lexicon, Inversago, GSK an. Research Support; Boehringer Ingelheim-Lilly, Merck, Janssen, Sanofi, AstraZeneca, CSL-Behring and Novo-Nordisk. M. Fralick: Consultant; singal1, proofdx. A. Weisman: None. L. Lovblom: None. B.A. Perkins: Advisory Panel; Abbott. Other Relationship; Novo Nordisk. Advisory Panel; Insulet Corporation, Nephris. Other Relationship; Medtronic. Advisory Panel; Sanofi, Vertex Pharmaceuticals Incorporated, Dexcom, Inc. Funding Diabetes Canada (Operating Grant OG-3-21-5572-BP)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".