Physician experiences with sodium-glucose cotransporter (SGLT2) inhibitors, a new class of medications in type 2 diabetes, and adverse effects.

Laura Patakfalvi,Anne-Sophie Brazeau,Kaberi Dasgupta

doi:10.1017/s1463423618000476

Laura Patakfalvi, Anne-Sophie Brazeau + Show 1 more

Open Access

https://doi.org/10.1017/s1463423618000476

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Abstract

The primary aim of our study is to identify physicians who have witnessed a complication attributed to sodium-glucose cotransporter (SGLT2) inhibitors. The secondary aim is to determine the type, severity, and setting of the event (inpatient versus outpatient). Diabetes is an increasing public health burden with 9.9% of Canadians expected to be diagnosed with it in 2020. A prominent change with respect to treatment options since the publication of the revised Diabetes Canada guidelines in May 2016 concerned the SGLT2 inhibitors. Their favorable clinical profile has increased interest among clinicians, but there is still reason for caution. Because these drugs are new, the balance of benefits versus risks is not well understood. We conducted a cross-sectional survey of all in-practice physicians (excluding pediatricians). Data were collected through an online survey. Our survey identified 154 physicians who have identified one or more adverse drug reactions (ADRs) related to SGLT2 inhibitor use. A total of 173 ADRs were identified. In total, 20.6% of family physician respondents had witnessed one or more ADRs. The most common complication is mycotic infection (82 cases) with 47% identified as a low level of severity and occurring mostly in the outpatient setting. The second most common complication is diabetic ketoacidosis (43 cases) with 67% identified as a high level of severity and occurring mostly in the inpatient setting. Other identified complications include hyperkalemia (6 cases), renal insufficiency (15 cases), and even amputation (2 cases). Our survey is the first to document real-world complications from SGLT2 inhibitors. In the outpatient setting, mycotic infections are most common and most often benign. In the inpatient setting, diabetic ketoacidosis is the most common and is severe. This is an important take-home message for family physicians to tailor their practice and vigilance according to the practice setting.

Highlights

Diabetes is an increasing public health burden with a predicted 10% of Canadians expected to be diagnosed by 2020 (Canadian Diabetes Association, 2011)
22 surveys were excluded. >From the 21 incomplete surveys, three respondents had reported more than 10 adverse drug reactions (ADRs) but did not email us to receive further instruction
Among the 142 respondents, 34.5% of the respondents had seen at least one patient with an SGLT2inhibitor-related complication (52% were female, 95% were from Quebec, 40% had less than five years of practice, and 60% were family physicians)

Summary

Introduction

Diabetes is an increasing public health burden with a predicted 10% of Canadians expected to be diagnosed by 2020 (Canadian Diabetes Association, 2011). With the increasing burden of disease and the scarce resources in health care, the Canadian Diabetes Association recommends integrating the Chronic Care Model for diabetes management. This organizational approach shifts the management of diabetes from specialist based on a multidisciplinary approach with the primary care physician at the forefront (Robinson et al, 2013). The newest class is the sodium-glucose cotransporter (SGLT2) inhibitors, including canagliflozin, dapagliflozin, and empagliflozin. These agents operate at the proximal renal tubule by inhibiting glucose and sodium reabsorption and increasing their excretion in the urine. They reduce glucose levels and lower blood pressure

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