Hamblin PS, Wong R, Ekinci EI, et al. - Lower body mass index (BMI) was revealed as a novel risk factor for higher ketones pre-colonoscopy in patients treated with sodium–glucose cotransporter 2 inhibitors (SGLT2i) for diabetes.

• SGLT2i have been linked with diabetic ketoacidosis at the time of colonoscopy.

• This cross-sectional, multicenter, observational study involved 37 SGLT2i-treated and 105 non-SGLT2i-treated type 2 diabetes patients, 65 impaired fasting glycaemia (IFG) and 151 normoglycemia, who were undergoing colonoscopy.

• Among participants, capillary glucose and ketones were measured.

• Negative correlations of BMI and duration since last SGLT2i dose with increasing ketones were found in SGLT2i-treated diabetes.

• Negative correlation of BMI and positive correlation of fasting duration was observed with ketones, in non-SGLT2i-treated diabetes.

• Correlation of only fasting duration with ketones was evident in those with IFG.

• Normoglycemic persons exhibited negative correlations with BMI and fasting glucose and positive correlations with fasting duration and age.

• According to multiple regression analysis of the whole cohort, age and fasting glucose were independently related to ketones, but only BMI continued to be independently associated in those who were SGLT2i-treated.