Counselling the potential adverse effects of gliflozins (SGLT2 inhibitor)

Glifozins cause an adverse effect that may confuse your patients. Do you what it is and how to best counsel on it?

Imagine this scenario. A patient comes into your pharmacy. She has type 2 diabetes and is currently already taking medicines to treat it. She tells you her GP wants her to try a new medicine, as her diabetes “isn’t controlled enough”. She isn’t too sure what her GP means by “isn’t controlled enough”, as her current medicines have stoped her excessive urination (polyuria) and excessive thirst (polydipsia). She also hasn’t gotten a genital infection (UTI or thrush) since beginning her current diabetic treatment. Her GP wants her to try a gliflozins (SGLT2 inhibitor).

Commonly prescribe gliflozins are dapagliflozin (Forxiga) and empagliflozin (Jardiance). They work by inhibiting reabsorption of glucose in the kidney via inhibiting sodium-glucose transport protein 2 (SGLT2). Basically, we are treating their high blood glucose levels (hyperglycaemia) by making them excrete glucose in urine (glycosuria). Due to the osmotic attraction of glucose, glycosuria contributes to polyuria and polydipsia; it also increases the chance of developing genital infection.

So how do we tell this patient, her new diabetes medicine may give her the same symptoms of her UNCONTROLLED diabetes?

If you are confused, you are not alone. Confusion on this often arises due to confusing the clinical end point of diabetes treatment. While the symptoms of glycosuria (polyuria and polydipsia) and increase genital infection risk are undesirable, the complications of long term hyperglycaemia and uncontrolled diabetes are worse. These complications include retinopathy (leading to blindness), nephropathy (leading to renal failure) and neuropathy leading to diabetic foot disorders (e.g. severe infections needing amputation).

In short, when a patient is started on a gliflozin we are weighing POTENTIAL RISK of having glycosuria related adverse effects, against the potential BENEFIT of having properly controlled diabetes.

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Posted by Memorise Medicine on Tuesday, July 24, 2018

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