J Korean Diabetes.  2019 Sep;20(3):127-135. 10.4093/jkd.2019.20.3.127.

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

Affiliations
  • 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. limsoo@snu.ac.kr

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.

Keyword

Acute kidney injury; Adverse events; Clinical trial; Sodium-glucose transporter 2 inhibitors

MeSH Terms

Acute Kidney Injury
Amputation
Anti-Bacterial Agents
Antihypertensive Agents
Canagliflozin
Diabetes Mellitus
Diuretics
Glucagon-Like Peptide-1 Receptor
Hypoglycemia
Hypoglycemic Agents
Hypotension
Incidence
Insulin
Lower Extremity
Risk Assessment
Urinary Tract Infections
Anti-Bacterial Agents
Antihypertensive Agents
Canagliflozin
Diuretics
Glucagon-Like Peptide-1 Receptor
Hypoglycemic Agents
Insulin
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