SGLT2 inhibitors: are they safe?

Abstract

Sodium-glucose linked transporter type 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs with positive cardiovascular and kidney effects. The aim of this review is to present the safety issues associated with SGLT2 inhibitors. Urogenital infections are the most frequently encountered adverse events, although tend to be mild to moderate and are easily manageable with standard treatment. Although no increased acute kidney injury risk was evident in the major trials, the mechanism of action of these drugs requires caution when they are administered in patients with extracellular volume depletion or with drugs affecting renal hemodynamics. Canagliflozin raised the risk of amputations and the rate of fractures in the CANVAS trial, although more data are necessary before drawing definite conclusions. The risk of euglycemic diabetic ketoacidosis seems to be minimal when the drugs are prescribed properly. Regarding other adverse events, SGLT2 inhibitors do not increase the risk of hypoglycemia even when co-administered with insulin, but a decrease in the dose of sulphonylureas may be needed. The available data do not point to a causative role of SGLT2 inhibitors on malignancy risk, however, these drugs should be used with caution in patients with known hematuria or history of bladder cancer. SGLT2 inhibitors seem to be safe and effective in the treatment of diabetes but more studies are required to assess their long-term safety.

Observational research on sodium glucose co‐transporter‐2 inhibitors: A real breakthrough?

“…The overall evidence suggests that SGLT2‐Is increase the risk of genital mycotic infections by four to five times according to the largest MA,51 although they are usually mild to moderate, can be adequately treated with standard medical therapy, and drug discontinuation is not required. Conversely, gathered evidence is not consistent for an increased risk of urinary infections, with MAs showing mixed results 52. However, clinicians should be aware that severe infections have been described, including pyelonephritis and urosepsis, especially in patients with urinary tract outlet obstruction.…”

“…Conversely, gathered evidence is not consistent for an increased risk of urinary infections, with MAs showing mixed results. 52 However, clinicians should be aware that severe infections have been described, including pyelonephritis and urosepsis, especially in patients with urinary tract outlet obstruction.…”

Place des inhibiteurs des SGLT2 dans le traitement du patient diabétique de type 2

“…Si les iSGLT2 offrent des bénéfices incontestables, en particulier chez les patients DT2 à très haut risque CV, ils sont aussi grevés de certaines manifestations indésirables qui peuvent limiter leur utilisation en pratique clinique [47,48].…”

“…Leur utilisation dans des périodes de jeûne prolongé avec privation de boisson, comme le Ramadan, n'est pas recommandée pour des raisons assez évidentes, en l'absence d'études validées. En cas de déshydratation importante, de rares cas d'insuffisance rénale fonctionnelle aiguë ont été rapportés [47,48].…”

Is cancer incidence modified by SGLT2 inhibitors?

“…В период 2018 -начала 2019 гг. не было представлено каких-либо новых доказательств в пользу «онкологической опасности» ингибиторов SGLT2 [13,14], хотя в одной из работ высказывалось здравое в практическом смысле мнение о том, что препараты этой группы должны с осторожностью назначаться лицам с гематурией и раком мочевого пузыря в анамнезе [13].…”