Is Jardiance (Empagliflozin) contraindicated in patients with a history of Diabetic Ketoacidosis (DKA)?

From the Guidelines

Jardiance is not absolutely contraindicated in patients with a history of diabetic ketoacidosis (DKA), but it should be used with caution and careful consideration of the patient's individual risk factors. When considering the use of Jardiance in patients with a history of DKA, it is essential to weigh the benefits of the medication against the potential risks. According to the 2025 standards of care in diabetes [ 1 ], SGLT2 inhibitors like Jardiance can increase the risk of DKA, particularly in individuals with insulin deficiency. However, this risk can be mitigated with proper patient education, sick-day planning, and monitoring for signs of DKA. Key considerations for using Jardiance in patients with a history of DKA include:

• Careful evaluation of the patient's current insulin deficiency status and overall health
• Education on recognizing the signs and symptoms of DKA and when to seek medical attention
• Implementation of sick-day planning to prevent DKA during periods of stress or illness
• Regular monitoring of the patient's condition and adjustment of the treatment plan as needed It is crucial to note that the benefits of Jardiance, including its glucose-lowering efficacy and cardiovascular benefits [ 1 ], may outweigh the risks for some patients. Ultimately, the decision to use Jardiance in a patient with a history of DKA should be made on a case-by-case basis, taking into account the individual patient's unique needs and circumstances.

From the FDA Drug Label

JARDIANCE is not recommended for patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. Ketoacidosis: Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level. If suspected, discontinue JARDIANCE, evaluate and treat promptly. Before initiating JARDIANCE, consider risk factors for ketoacidosis Patients on JARDIANCE may require monitoring and temporary discontinuation of therapy in clinical situations known to predispose to ketoacidosis.

Jardiance is not contraindicated in patients with a history of DKA, but it is not recommended for the treatment of diabetic ketoacidosis.

• The drug label recommends considering risk factors for ketoacidosis before initiating JARDIANCE and monitoring patients who are at risk.
• Patients with a history of DKA may require monitoring and temporary discontinuation of therapy in clinical situations known to predispose to ketoacidosis 2.

From the Research

Jardiance Contraindication in Patients with History of DKA

• Jardiance (empagliflozin) is not explicitly contraindicated in patients with a history of diabetic ketoacidosis (DKA) 3, 4.
• However, studies have shown that SGLT2 inhibitors, including empagliflozin, carry a risk of inducing euglycemic diabetic ketoacidosis under certain circumstances such as acute illness, decreased carbohydrate intake, decrease in dose, or discontinuation of insulin 3, 4.
• Patients with a history of DKA may be at increased risk of developing euglycemic DKA when taking empagliflozin, and therefore, careful monitoring and management are necessary 5, 6.
• The EASE trials, which evaluated the safety and efficacy of empagliflozin as adjunctive to insulin therapy in type 1 diabetes, found that adjudicated diabetic ketoacidosis occurred more frequently with empagliflozin 10 mg and 25 mg, but was comparable between empagliflozin 2.5 mg and placebo 7.

Key Considerations

• Empagliflozin may increase the risk of diabetic ketoacidosis, particularly in patients with a history of DKA 3, 4.
• Patients taking empagliflozin should be monitored for signs and symptoms of DKA, including elevated urine ketones, and managed promptly if DKA occurs 5, 6.
• The benefits and risks of empagliflozin should be carefully weighed in patients with a history of DKA, and alternative treatments may be considered if necessary 6, 7.