Adverse Effects and Safety of SGLT2 Inhibitor Use among Patients with Type 2 Diabetes: Findings from RCT Evidence
Abstract
Sodium-glucose cotransporter 2 (SGTL2) inhibitors, a novel class of glucose-lowering agents, act in an insulin-independent manner by increasing urinary glucose excretion. In addition to reduce hyperglycemia, SGTL2 inhibitor exerts beneficial effects on cardiovascular risk factors (e.g., lower blood pressure and enhance weigh loss), which may confer additional health benefits for type 2 diabetes patients. The EMPA-REG OUTCOME trial showed that empagliflozin not only reduced the risk of major adverse cardiovascular events but also slowed down the progression of kidney disease compared with placebo. However, some evidence indicated an increased risk of composite renal events among patients using dapagliflozin. The beneficial cardiovascular and renal effects of EMPA-REG OUTCOME trial representing a class effect or a specific drug effect warrants to be further investigated. SGLT2 inhibitors were associated with increased risks of genital mycotic infections and urinary tract infections. Some mechanisms indicated that SGLT2 inhibitor might lead to diabetic ketoacidosis and bone fracture. These risks remain uncertain, though some evidence from the meta-analyses did not find any significantly increased risks of diabetic ketoacidosis and bone fracture. The findings of ongoing trials will provide more definitive evidence on safety of SGLT2 inhibitors.
[N A J Med Sci. 2017;10(2):78-82. DOI: 10.7156/najms.2017.1002078]
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