An acute metabolic complication of diabetes mellitus, especially type 1, is diabetic ketoacidosis (DKA), which is due to an increase in blood ketone concentrations. Sodium/glucose co-transporter-2 inhibitor (SGLT2-i) drugs have been associated with the occurrence of a particular type of DKA defined as euglycemic (euDKA), characterized by glycemic levels below 300 mg/dL. A fair number of euDKA cases in SGLT2-i-treated patients have been described, especially in the last few years when there has been a significant increased use of these drugs. This form of euDKA is particularly insidious because of its latent onset, associated with unspecific symptomatology, until it evolves (progressing) to severe systemic forms. In addition, its atypical presentation can delay diagnosis and treatment. However, the risk of euDKA associated with SGLT2-i drugs remains relatively low, but it is essential to promptly diagnose and manage it to prevent its serious life-threatening complications. In this narrative review, we intended to gather current research evidence on SGLT2i-associated euDKA from randomized controlled trials and real-world evidence studies, its diagnostic criteria and precipitating factors.

Background: Alexithymia has been recognised as a predictor of negative outcomes in various chronic conditions, including type 2 diabetes mellitus (T2DM). However, evidence concerning its role in type 1 diabetes mellitus (T1DM) remains limited. This systematic review aims to explore the relationship between alexithymia and T1DM. Methods: In June 2025, following PRISMA guidelines, a systematic review was conducted using Scopus, PubMed, and Web of Science databases. Studies specifically addressing the relationship between alexithymia and type 1 diabetes mellitus were analysed. The search strategy included the keywords “Alexithymia” AND (“Type 1 Diabetes Mellitus” OR “T1DM”). The NIH Study Quality Assessment Tool was employed to evaluate the methodological quality of the selected studies. Results: Fifteen studies met the inclusion criteria. The systematic analysis of the literature highlighted three dominant themes: alexithymia was found to be associated with patients’ health status concerning weight and obesity, glycaemic control, and psychopathological symptoms. Moreover, alexithymia emerged as a potential predictor of adverse outcomes in T1DM self-management. Conclusions: Available evidence suggests that alexithymia has a clinically relevant impact on the management of T1DM. However, further research involving larger samples and longitudinal designs is needed to bridge the gap with other chronic conditions. Promoting evidence-based research in this area is aligned with the need for targeted psychological assessment, specific interventions, and improved care strategies.