Drug

SGLT2 Inhibitors: Balancing Benefits and Risks

SGLT2 inhibitors, Managing Type 2 Diabetes (T2D) often requires selecting medications that balance effectiveness with safety. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are widely used for their ability to lower blood sugar, promote weight loss, and improve cardiovascular outcomes. However, recent research highlights potential risks associated with these medications, particularly concerning peripheral artery disease (PAD) and related surgical procedures.

Key Findings from Recent Research

A study conducted among U.S. veterans with Type 2 Diabetes investigated the effects of adding SGLT2 inhibitors or dipeptidyl peptidase-4 (DPP-4) inhibitors to existing treatments. The main outcome was the time to a first PAD-related surgical event, such as amputation or vascular revascularization.

Results:

Higher PAD Risk: SGLT2 inhibitor users experienced more PAD-related surgical events compared to DPP-4 inhibitor users (874 cases vs. 780 cases).
Incident Rates: 11.2 events per 1,000 person-years for SGLT2 inhibitors vs. 10.0 for DPP-4 inhibitors.
Cumulative Risk: After four years, the likelihood of a PAD-related surgery was 4.0% for SGLT2 inhibitor users, compared to 2.8% for DPP-4 users.
Specific Risks: Increased risks of amputation (hazard ratio [HR]: 1.15) and revascularization (HR: 1.25).

What Are SGLT2 Inhibitors?

SGLT2 inhibitors work by blocking glucose reabsorption in the kidneys, leading to its excretion through urine. Common drugs in this class include empagliflozin, canagliflozin, and dapagliflozin. While they provide significant metabolic and cardiovascular benefits, their impact on PAD risk requires careful consideration.

SGLT2 inhibitors Potential Side Effects

PAD and Vascular Risks: The study suggests a notable association between SGLT2 inhibitors and PAD-related surgeries. Patients with pre-existing PAD or high vascular risk should consult their doctor before starting this therapy.
Genitourinary Infections: Increased urinary glucose levels can raise the risk of urinary tract and genital infections.
Dehydration: Enhanced diuresis can lead to dehydration and associated symptoms.
Ketoacidosis: Rare cases of diabetic ketoacidosis (DKA) without significant hyperglycemia have been reported.

Tips for Safe Use

Pre-treatment Assessment: Evaluate vascular health, especially in patients with known PAD or a history of vascular complications.
Monitor Symptoms: Be alert for signs of infection, dehydration, or circulatory issues.
Maintain Hydration: Adequate fluid intake can help mitigate dehydration risks.
Regular Follow-ups: Ensure routine monitoring of blood sugar levels, kidney function, and cardiovascular health.

Conclusion

SGLT2 inhibitors remain a valuable option in T2D management but should be prescribed with caution, particularly for patients at high risk for PAD. Collaborative decision-making between patients and healthcare providers is key to optimizing treatment outcomes.