Potential Safety Issues with Use of Sodium-Glucose Cotransporter 2 Inhibitors, Particularly in People with Type 2 Diabetes and Chronic Kidney Disease.

Abstract

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a major advance in the fields of diabetology, nephrology, and cardiology. The cardiovascular and renal benefits of SGLT2 inhibitors are likely largely independent of their glycaemic effects, and this understanding is central to the use of these agents in the high-risk population of people with type 2 diabetes and chronic kidney disease. There are a number of potential safety issues associated with the use of SGLT2 inhibitors. These include the rare but serious risks of diabetic ketoacidosis and necrotising fasciitis of the perineum. The data regarding a possibly increased risk of lower limb amputation and fracture with SGLT2 inhibitor therapy are conflicting. This article aims to explore the potential safety issues associated with the use of SGLT2 inhibitors, with a particular focus on the safety of these drugs in people with type 2 diabetes and chronic kidney disease. We discuss strategies that clinicians can implement to minimise the risk of adverse effects including diabetic ketoacidosis and volume depletion. Risk mitigation strategies with respect to SGLT2 inhibitor-associated diabetic ketoacidosis are of particular importance during the current coronavirus disease 2019 (COVID-19) pandemic.

• Authors: Tamara Y Milder, Sophie L Stocker, Richard O Day, Jerry R Greenfield
• Journal: Drug safety (Drug Saf) Vol. 43 Issue 12 Pg. 1211-1221 (12 2020) ISSN: 1179-1942 [Electronic] New Zealand
• PMID: 33095409 (Publication Type: Journal Article, Review)

Chemical References

• Sodium-Glucose Transporter 2 Inhibitors

Topics

• Acute Kidney Injury (chemically induced)
• Amputation, Surgical (statistics & numerical data)
• Diabetes Mellitus, Type 2 (complications, drug therapy, metabolism)
• Diabetic Ketoacidosis (chemically induced)
• Fasciitis, Necrotizing (chemically induced)
• Fournier Gangrene (chemically induced)
• Fractures, Bone (chemically induced)
• Humans
• Hypoglycemia (chemically induced)
• Hypovolemia (chemically induced)
• Patient Education as Topic
• Perineum
• Renal Insufficiency, Chronic (complications)
• Reproductive Tract Infections (chemically induced)
• Risk Factors
• Sodium-Glucose Transporter 2 Inhibitors (adverse effects)
• Urinary Tract Infections (chemically induced)