Common Diabetes Meds Tied to Complication Risk

Untreated, DKA can lead to death, the ADA said.
The new study included more than 200,000 people with type 2 diabetes who started using SGLT2 inhibitors between 2013 and 2018. They were compared to a matched group of people who took a different class of diabetes medications called DPP-4 inhibitors.
During the study, 521 people were diagnosed with DKA.
For people taking SGLT2 inhibitors, the risk of DKA was nearly three times higher, the study found. And, risk varied with the type of SGLT2 inhibitor used.
Dapagliflozin (Farxiga) was linked to an 86% increase in DKA risk, while patients using empagliflozin (Jardiance) had 2.5 times the risk of DKA compared to those on DPP-4s, the study found. Canagliflozin (Invokana) was associated with 3.6 times higher odds of DKA.
The good news, however, is that you can take steps to prevent DKA and get the benefits of SGLT2 inhibitors.
Goyal said the risk of DKA is highest when someone begins taking an SGLT2 inhibitor. Staying hydrated is a good way to help prevent it. It’s also important to check with your diabetes doctor before taking any new medications. And, find out how often you should check your blood sugar levels.
She said it’s also important to be aware of the DKA symptoms so you can seek treatment without delay if needed.
Symptoms include dry mouth, frequent thirst and urination, fatigue, nausea and vomiting, trouble concentrating and fruity-smelling breath, according to the ADA.
Goyal said SGLT2 inhibitors are a potent and effective class of medications.
“They really help with diabetes and heart failure, and can even help with cardiovascular risk in people who don’t yet have heart disease,” she said. “These medications are really good for people with kidney disease, too. And they’re easy. One pill, once a day.”  
Filion said all drugs have benefits and risks that should be brought to patients’ attention.
“These drugs have been shown to lower blood glucose levels and have benefits for the heart and kidneys. They also have some risks,” he said. “Patients and physicians need to discuss the benefits and risks, particularly the risk factors for DKA.”
The report was published online July 28 in the Annals of Internal Medicine.

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