The Effects of Sodium-Glucose Co-transporter 2 Inhibition on Plasma and Urine Ketones in Type 1 Diabetes
Bibliographic record
Abstract
Background: Adjunctive-to-insulin SGLT2 inhibition (SGLT2i) in type 1 diabetes (T1D) has meaningful metabolic benefits but can increase risk of ketoacidosis. Knowledge gaps include understanding ketone metabolism with and without SGLT2i treatment in T1D, and whether ketoacidosis risk in females is physiological or behavioral.Methods: Metabolomic analysis of plasma and urine beta-hydroxybutyrate and acetoacetate from stored baseline and 8-week eu- and mild hyper-glycemic samples in the 40-person single-arm Adjunctive-To-Insulin Renal MechAnistic (ATIRMA) trial of empagliflozin. Results: A significantly greater production of ketones even during mild hyperglycemia compared to euglycemia was observed, but this was compensated by increased urinary excretion leading to similar plasma concentrations. However, SGLT2i attenuated this increased excretion, resulting in higher plasma concentrations, particularly in females. Conclusions: Even mild hyperglycemia is associated with greater ketone production, compensated by urinary excretion. SGLT2i further exaggerates excess production and impaired excretion especially in females, indicating physiological rather than behavioral risk for ketoacidosis.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
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".