Safety Issues with Sodium-Glucose Cotransporter 2 Inhibitors: Clinical Considerations

Soo Lim

doi:10.4093/jkd.2019.20.3.127

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Lim: Safety Issues with Sodium-Glucose Cotransporter 2 Inhibitors: Clinical Considerations

Opinion

The Journal of Korean Diabetes 2019; 20(3): 127-135.

Published online: 30 September 2019

DOI: https://doi.org/10.4093/jkd.2019.20.3.127

Safety Issues with Sodium-Glucose Cotransporter 2 Inhibitors: Clinical Considerations

Soo Lim

Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Corresponding author: Soo Lim. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea, limsoo@snu.ac.kr

Received 29 July 2019 Accepted 31 July 2019

Korean Diabetes Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetes mellitus (DM) is linked to poor outcomes after cardiovascular events and renal complications. Recently, novel antidiabetic agents, such as dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide-1 receptor agonists, are available. Among them, studies on SGLT2 inhibitors show favorable results both for cardiovascular and renal outcomes. SGLT2 inhibitors are well-tolerated with few side effects. Urinary tract infection has not been increased in many studies of SGLT2 inhibitors. The most frequent side-effect associated with SGLT2 inhibitors is mycotic infections in the genital area. Fortunately, these are generally mild in severity and easily treated with antibiotics. Hypoglycemia can occur when an SGLT2 inhibitor is added to sulfonylureas or insulin. Volume depletion and hypotension can be minimized by adjusting diuretics or other antihypertensive agents. Of note, acute kidney injury was observed in a few studies with SGLT2 inhibitors. However, in more recent observational studies, acute kidney injury was less frequently observed in conjunction with SGLT2 inhibitor treatment. An increased incidence of lower extremity amputation and fractures was observed in a large study with canagliflozin but not with other SGLT2 inhibitors. In conclusion, it is critical to understand the benefits and risks associated with use of SGLT2 inhibitors.

Keywords: Acute kidney injury, Adverse events, Clinical trial, Sodium-glucose transporter 2 inhibitors

Figures and Tables

Table 1

Conditions or medications that should be used with caution when patients treated with SGLT2 inhibitors are sick (sick day strategy)

SGLT2, sodium-glucose cotransporter 2; ACE, angiotensin converting enzyme; ARBs, angiotensin receptor blockers.

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