Table 5.

Comparison of SGLT-2 inhibitors with other anti-diabetic drugs with respect to ketogenesis.

Anti-Diabetic Agent	Mechanism of Action	Ketogenic Potential
SGLT-2 Inhibitors	Inhibit glucose reabsorption in the kidney, leading to increased urinary glucose excretion	Promote mild ketogenesis due to increased free fatty acid availability and decreased insulin secretion
Metformin	Decreases hepatic glucose production and improves insulin sensitivity	Low potential → Does not promote ketogenesis
Sulfonylureas	Stimulate insulin secretion from β cells in the pancreas	Low potential → Does not promote ketogenesis
DPP-4 Inhibitors	Inhibit the enzyme DPP-4, which breaks down incretin hormones that stimulate insulin secretion	Low potential → Does not promote ketogenesis
GLP-1 Receptor Agonists	Mimic the action of GLP-1, an incretin hormone that stimulates insulin secretion and decreases glucagon secretion	Low potential → Does not promote ketogenesis
Insulin	Facilitates glucose uptake by cells and decreases hepatic glucose production	Low potential → Does not promote ketogenesis

Abbreviations: SGLT-2—sodium–glucose cotransporter-2; β—beta; DPP-4—dipeptidyl peptidase 4 (gliptins); GLP-1—glucagon-like peptide-1.