Safety profile of sodium glucose co-transporter 2 (SGLT2) inhibitors: A brief summary

Abstract

A new therapeutic class of oral agents firstly used for the treatment of type 2 diabetes mellitus is represented by gliflozines or sodium-glucose co-transporter 2 (SGLT2) inhibitors. SGLT2 inhibitors might be effective alone or in combination with any other drugs. This therapeutic class currently includes five agents: canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, and sotagliflozin. SGLT2 inhibitors prevent the renal reabsorption of filtered glucose and sodium by blocking the SGLT2 co-transporters in the proximal convoluted renal tubule, facilitating glucose excretion in the urine (glycosuria) and lowering blood glucose levels. SGLT2 inhibitors have also shown to have pleiotropic effects and determine cardiovascular and renal prevention, thus leading to an extension of their therapeutic indication to include the heart failure. Despite their clinical benefits, warnings about adverse events have been implemented by Regulatory Agencies in the product's information since their introduction to the market. In particular, SGLT2 inhibitors have shown a strong impact on a high number of risk factors. They can cause hypoglycaemia, hypotension, lower limb amputation, fractures, genito-urinary infections, and diabetic ketoacidosis with different frequencies of onset. Despite some of these events are rare, they can lead to serious and dangerous complications, highlighting the importance of a strict monitoring of patients. Overall, SLGT-2 inhibitors are effective antidiabetic drugs with favorable advantages in renal and cardiovascular protection, and with a generally well-tolerated safety profile. This review aims to summarize the safety profile of SGLT2 inhibitors available in the market.

Influence of Age, Gender, Frailty, and Body Mass Index on Serum IL-17A Levels in Mature Type 2 Diabetic Patients

“…Regarding selection of prescribed drugs, special focus was put on newly recommended cardio- and renal-protective antidiabetic drugs, glucagon-like peptide-1 receptor agonist (GLP1ra), and sodium-glucose cotransporter-2 inhibitors (SGLT2inh), for their potential anti-inflammatory effects [ 41 , 45 ]. An old-fashioned first-line antidiabetic drug, metformin, and statins are widely prescribed to diabetic patients, and for both drugs, besides their metabolic effects, direct involvement in IL-17A signaling has been identified [ 46 , 47 ].…”

From liver to hormones: The endocrine consequences of cirrhosis

“…SGLT-2i are comparable in efficacy to GLP-1 RA in reducing hepatic decompensations[ 117 ]. A study found that the use of SGLT-2i in cirrhotic patients prevents worsening liver function and hepatic fibrosis[ 129 ]. There are also case reports where the addition of SGLT-2i controlled ascites, hydrothorax, and peripheral edema[ 130 ].…”

SGLT-2 Inhibitors in Heart Failure: A Review of Current Evidence

“…There were initial concerns about the increased risk of hypoglycemia and urinary tract infections, but a significant increase in these 2 adverse events has not been reported across several trials. 22 23) SGLT-2 do increase the risk of genital mycotic infections, but the absolute risk is low and considering the benefit with these drugs and the easily treatable nature of genital mycotic infections, the recommendations are to continue treatment, unless these infections are recurrent. 1 11) Fournier’s gangrene, defined as necrotizing fasciitis of perineal soft issues, has also been reported as a rare adverse effect 24) and has been identified as a safety warning.…”