Administration of Sodium-Glucose Co-transporter 2 Inhibitors Could Accelerate Dehydration in Poorly-Controlled Diabetic Patients, Proposing an Option not to Increase Glucosuria but to Decrease Carbohydrate Intake during Hyperglycemia.
Sodium-glucose co-transporter 2 inhibitors, a new class of anti-diabetic agents,
have been recently approved for treatment of type 2 diabetes.
It was unexpected that possible adverse effects of SGLT2 inhibitors, including fatal events,
were reported frequently soon after the first one was marketed in April 2014 in Japan.
In poorly-controlled diabetic patients, pre-existing osmotic diuresis is supposed to
be augmented by the administration of SGLT2 inhibitors, possibly leading to an acceleration
of their dehydration in spite of amelioration of hyperglycemia.
It may be reasonable that not only water but a small amount of salt needs to be supplemented
with, if necessary, to prevent plasma volume depletion with salt loss.
Otherwise, it seems to be a plausible option for such patients to decrease carbohydrate intake
by 50 to 100 g of carbohydrate per day during hyperglycemia, instead of excreting a similar
amount of glucose into urine with SGLT2 inhibitors.
Sodium-glucose co-transporter 2 inhibitors, a new class of anti-diabetic
agents, have been recently approved for treatment of type 2 diabetes, since dapagliflozin was
first approved by the European Medicines Agency in November 2012.
SGLT2 inhibitors decrease hyperglycemia independently of insulin by increasing urinary
glucose excretion through the inhibition of glucose reabsorption in the proximal renal tubule.
They have some advantages including modest weight loss, low risk of hypoglycemia and mild
decrease of blood pressure.
Diabetes Res Open J. 2015; 1(3): 72-74. doi: 10.17140/DROJ-1-111