Diabetes Treatment with SGLT2 Inhibitors
The Food and Drug Administration (FDA) has approved several SGLT2 inhibitors, such as empagliflozin (Jardiance), to treat type 2 diabetes. These medications are a newer, second line of medical treatment for managing blood sugar levels in people with type 2 diabetes.
SGLT2 inhibitors work by blocking the reabsorption of glucose from the kidneys back into the bloodstream, causing excess glucose to be expelled from the body through the urine. This can help lower blood sugar levels and improve glucose control.
While SGLT2 inhibitors provide important benefits, their use requires careful monitoring due to potential adverse events. Dr. Rettinger, a medical professional, advises against prescribing SGLT2 inhibitors to individuals who are bed-bound, have very low blood pressure, may be prone to diabetic ketoacidosis, have a history of drug or alcohol misuse, frequent urinary tract infections or yeast infections, very low bone density or frequent falls, or diabetes-related foot ulcers.
Polyuria, or excessive urination, is a common side effect of SGLT2 inhibitors due to osmotic diuresis. Genital tract infections, particularly fungal infections, affect about 10-15% of women and less commonly men. These infections are up to four times more frequent compared to non-users.
Euglycemic diabetic ketoacidosis (euDKA), a serious condition characterized by ketoacidosis with normal or near-normal blood glucose levels, is a rare but potential risk with SGLT2 inhibitors. Although more typical in type 1 diabetes, it can occur in type 2 patients, especially during acute illness, insulin dose reduction, or omission.
Skin infections such as Fournier’s gangrene, a severe and potentially fatal infection of the genital/groin area, are estimated to be about 12 times more common in patients on SGLT2 inhibitors than other diabetes drugs, though still very rare.
Possible increased risks of amputations and fractures have been noted in some studies, but further research is needed to confirm this link. Dehydration and orthostatic hypotension, particularly in elderly or frail individuals, may also be risks associated with SGLT2 inhibitors.
Clinical guidance includes discontinuing SGLT2 inhibitors in cases of severe or recurrent genital infections, urinary tract infections, or when euDKA occurs. They are also recommended to be paused perioperatively due to increased risk of ketoacidosis during surgical stress and fasting.
Despite these potential risks, SGLT2 inhibitors offer several benefits. They may help protect the heart, particularly for people with heart failure, as some agents in this class reduce the risk of death. They may also help some people lower their blood sugar levels.
The benefits and risks of SGLT2 inhibitors should be discussed with a doctor to determine if they are appropriate and effective for an individual. One study suggests that SGLT2 inhibitors reduce the risk of dialysis, transplantation, or death due to kidney disease in people with type 2 diabetes.
Several combination drugs that include SGLT2 inhibitors are also FDA-approved for use in people with type 2 diabetes. These drugs may offer additional benefits, such as reduced HbA1c levels, increased high-density lipoprotein (good cholesterol), decreased intestinal absorption of low-density lipoprotein (LDL, bad cholesterol), decreased hypertension, sustained weight loss, and reduced albuminuria (a sign of kidney disease).
In summary, while SGLT2 inhibitors provide important benefits in glucose control and cardiovascular/renal protection, their use requires careful monitoring for these potential adverse events, with particular attention to infections, ketoacidosis, and volume depletion risks. It is crucial to discuss the benefits and risks with a healthcare provider to determine if SGLT2 inhibitors are the right choice for managing type 2 diabetes.
- Despite the potential risks of genital infections, urinary tract infections, and euglycemic diabetic ketoacidosis, SGLT2 inhibitors offer benefits such as heart protection and improved glucose control.
- People seeking treatment for type 2 diabetes may consider SGLT2 inhibitors, but their use requires careful monitoring due to potential side effects like skin infections, amputations, fractures, dehydration, and orthostatic hypotension.
- switchers from other diabetes drugs might want to consider the benefits of SGLT2 inhibitors, which include reduced HbA1c levels, increased good cholesterol, decreased LDL cholesterol, decreased hypertension, sustained weight loss, and reduced albuminuria.
- naive patients with type 2 diabetes should be cautious about the potential risks associated with SGLT2 inhibitors, such as the increased risk of infections, ketoacidosis, and volume depletion risks.
- Given the conflicting benefits and risks of SGLT2 inhibitors, a person with type 2 diabetes, type-2 diabetes seeks, or medical-conditions related to chronic diseases, should consult with a healthcare provider to determine the appropriateness and effectiveness of this treatment.
- Science and medical research continue to evaluate the long-term side effects of SGLT2 inhibitors, and further studies are needed to confirm the increased risks of amputations, fractures, and skin infections associated with their use.
