Sodium glucose‐linked transport protein 2 inhibitors: An overview of genitourinary and perioperative implications

Abstract

Sodium glucose‐linked transport protein 2 inhibitors are relatively novel drugs, used for the treatment of type 2 diabetes mellitus. Their use since Pharmaceutical Benefits Scheme approval in Australia has increased drastically, possibly due to the low risk of hypoglycemic events and their advertised cardiovascular mortality benefits. However, as with any novel drug, adverse effects regarding their use require medical practitioner awareness for optimal patient outcomes. This paper aims to cover the major urological implications, including those pertinent perioperatively, that concern this class of drugs. There is a clear risk of developing genital mycotic infections with the use of sodium glucose‐linked transport protein 2 inhibitors, including serious infections such as Fournier’s gangrene. Evidence for developing urinary tract infections has been mixed. Sodium glucose‐linked transport protein 2 inhibitor‐induced lower urinary tract symptoms may have impacts on quality of life via pollakiuria and nocturia, of which there are increased reports. Perioperative use increases the risk of euglycemic diabetic ketoacidosis. It is recommended that sodium glucose‐linked transport protein 2 inhibitors be ceased perioperatively.

New Diabetic Medication Sodium-Glucose Cotransporter-2 Inhibitors Can Induce Euglycemic Ketoacidosis and Mimic Surgical Diseases: A Case Report and Review of Literature

“…The identified papers included reports about bariatric ( 1 , 27 , 31 – 37 ), cardiothoracic ( 2 , 38 – 46 ), neuro- ( 47 – 49 ), vascular ( 50 ), orthopedic ( 51 ), urologic ( 52 ), ophthalmologic ( 53 ), and visceral ( 2 , 49 , 54 , 55 ) surgery. Most of the interventions were elective, and therefore the time of withhold and restart were predominantly mentioned.…”

“…Reported risk factors are prolonged fasting ( 27 ) and/or reduced oral intake ( 33 ) due to vomiting or dietary changes prior to weight loss surgery (very-low-calory diet) ( 34 ), huge weight loss after bariatric surgery ( 27 ), acute infection ( 38 ), basal insulin discontinuation and/or dose reduction before and/or after surgery ( 27 , 31 , 32 ), continuation of SGLT2-I medication perioperatively ( 46 , 55 ), or withholding within 24–48 h prior to elective interventions ( 47 , 54 ). Patients undergoing bariatric surgery might be at special risk for the development of EDKA because of surgical stress, perioperative diet changes, and prolonged fasting periods ( 31 , 34 , 36 , 37 , 52 , 59 , 61 ). The incidence of EDKA in diabetic cardiac bypass surgery patients indicates a worrisome potential of this side effect ( 2 , 38 – 46 ).…”

“…This work shall raise the awareness that besides the proven beneficial effects of SGLT2-I (such as lowering of blood glucose, systolic blood pressure, and body weight), serious side effects can occur: iatrogenic-induced glucosuria might lead to genital fungal and/or urinary tract infections ( 22 ), and rare cases of Fournier's gangrene have been reported ( 23 , 52 ). On top, reports about SGLT2-I-induced EDKA are rising ( 54 , 62 ).…”

Association of SGLT-2 inhibitors with bacterial urinary tract infection in type 2 diabetes

“…Although the mechanism underlying UTI associated with SGLT-2i has not been clearly de ned, glucosuria, effect of SGLT-2i, may provide a microorganismfavoring environment [1,21]. However, osmotic diuresis, by maintaining urinary ow, may counteract the microorganism-favoring milieu [22].…”

Prodromal Fournier’s Gangrene: A Potential Opportunity for Early Intervention

“…Factors like sodium glucose-linked transport protein 2 inhibitor use, obesity, and chronic immunosuppression could all potentially be included in a risk calculator to help differentiate the cellulitic patient from a prodromal patient. 5,6 By leading this charge, urologists may be able to convert FG into a disease process characterized by earlier, planned, and more limited debridement and hopefully improve morbidity and mortality.…”