News for People with Type 2 Diabetes

A new class of drugs has shown significant promise for treating type 2 diabetes, but research has also shown some risk.

Millions of Americans have type 2 diabetes or prediabetes. The condition typically develops over time and prevents your body from using insulin properly. The result is high blood sugar or glucose, levels that in turn, can lead to some dangerous health complications.

While some people with type 2 diabetes can keep their blood sugar under control with lifestyle changes such as diet, exercise, and weight loss, others require medication to keep their blood sugar in check. One of the most promising medicines for regulating blood sugar is the sodium-glucose transporter 2 (SGLT2) inhibitor.

What is SGLT2?

SGLT2 is a chemical naturally found in the kidneys. It helps your body reabsorb sodium and glucose. SGLT2 inhibitors block this action, which has proven effective in lowering glucose in patients who have trouble regulating it through other lifestyle changes and other medications.

“The SGLT2 inhibitors are becoming quite popular because they are available in the form of a pill, do not cause hypoglycemia, and recent data show their beneficial effects on the heart and kidneys,” says Rajesh Garg, M.D., director of the Comprehensive Diabetes Center at the University of Miami Health System.

Thus far, the research on these medications has been quite promising. Typically, patients taking the inhibitor lower their levels of a blood component, known as HbA1c, by up to one percent after six months of therapy. Weight loss was also reported in those taking the medication.

A potential risk for a dangerous disease

A few recent studies have found a potential risk to taking SGLT2 inhibitors, and that’s an increased chance of developing diabetic ketoacidosis (DKA). This is a rare but dangerous condition in which patients have high levels of both glucose and ketones.

Potential symptoms of DKA:

• Nausea
• Vomiting
• Abdominal pain
• Rapid breathing
• Loss of consciousness

* If you have these, emergency medical treatment is required.

“DKA is a potentially life-threatening emergency that typically occurs in type 1 diabetes,” says Dr. Garg. “However, DKA can happen in patients with type 2 diabetes under conditions of extreme stress like severe infections, heart attack, and major surgery.”

What’s even more unusual, notes Dr. Garg, is that some patients on SGLT2 inhibitors can develop DKA symptoms even with normal glucose levels. “Therefore, if a patient taking SGLT2 inhibitors develops symptoms of DKA like nausea, vomiting, abdominal pain or rapid breathing, blood or urine ketones should be tested, and DKA should be suspected even if blood sugar is normal,” he says. “However, this condition is rare and happens mostly in high-stress conditions like infection, trauma, and surgery.”

The bottom line on SGLT2 Inhibitors & DKA

Despite this research, Dr. Garg says that the benefits of SGLT2 inhibitors can be substantial, and the potential side effects are rare. The FDA currently recommends stopping using the inhibitor 24 hours prior to surgery, as the chances of developing DKA are higher after surgery.

SGLT2 inhibitors are an excellent class of drugs and a major advance in the treatment of type 2 diabetes. However, like any other drug, one must exercise caution to prevent the side effects of these drugs.

Dr. Rajesh Garg

“While DKA is a serious side effect, it is rare and can be prevented if SGLT2 inhibitors are used carefully and stopped under conditions that increase the risk of DKA,” he says. A greater risk of SGLT2 inhibitors, says Dr. Garg, is genitourinary infections resulting from excess sugar in the urine. “Patients need to be extra cautious in the cleanliness of their private parts and consult their physician for any redness, pain, or discharge in the genital area.”

Wyatt Myers is a contributing writer for UMiami Health News.

Tags: diabetes treatment in miami, diabetic ketoacidosis, Dr. Rajesh Garg, SGLT2 inhibitor, sodium-glucose transporter 2, type 2 diabetes