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Discussion| Mortality due to DKA and hyperosmolar hyperglycemic state increased from 1999 to 2019 with disparities by age and area deprivation. The etiology of this upward trend in mortality is likely multifactorial, and interpretation of 2020 to 2022 data is complicated by the COVID-19 pandemic. Inadequate preventive care, disproportionately affecting disadvantaged populations and exacerbated by the pandemic, likely contributes to these findings. Recent practice trends seeking to avoid hypoglycemia by relaxing glycemic targets may have led to an increased risk of hyperglycemia. 3, 4 Sodium-glucose cotransporter 2 inhibitors, first approved in 2013, are associated with increased risk of DKA and may also play a role in these results. 6