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There is much debate surrounding the tolerability of an increased risk of DKA, with comparisons being made with troglitazone and its subsequent removal from the market where the risk of fatal liver failure was greater than the current risk of DKA with SGLT2i use [31]

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Elevations in MDH activity was found to correlate with morphological changes after dosing with thioacetamide, dimethylonitrosamine and diethanolamine [98]

Moreover, the abundance of erythrocytes in circulation [23] raises an additional question concerning the possible immunogenic consequences of erythrocyte RCDs