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

Authors

  • Yuji Aoki Department of Internal Medicine, National Hospital Organization Matsumoto Medical Center Matsumoto Hospital, Japan

DOI:

https://doi.org/10.17140/DROJ-1-111

Keywords:

SGLT2 inhibitors, Glucosuria Osmotic diuresis, Dehydration Carbohydrate intake

Abstract

Sodium-glucose co-transporter 2 (SGLT2) 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.

References

Mikhail N. Place of sodium-glucose co-transporter type 2 in-hibitors for treatment of type 2 diabetes. World J Diabetes. 2014; 5: 854-859. doi: 10.4239/wjd.v5.i6.854

Vasilakou D, Karagiannis T, Athanasiadou E, et al. Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: a system-atic review and meta-analysis. Ann Intern Med. 2013; 159: 262- 274. doi: 10.7326/0003-4819-159-4-201308200-00007

Scholl-Buergi S, Santer R, Ehrich JHH. Long-term outcome of renal glucosuriatype 0: the original patient and his natural history. Nephrol Dial Transplant. 2004; 19: 2394-2396. doi: 10.1093/ndt/gfh366

Calado J, Sznajer Y, Metzger D, et al. Twenty-one additional cases of familial renal glucosuria: absence of genetic heteroge-neity, high prevalence of private mutations and further evidence of volume depletion. Nephrol Dial Transplant. 2008; 23: 3874- 3879. doi: 10.1093/ndt/gfn386

Cherney DZI, Perkins BA, Soleymanlou N, et al. Renal he-modynamic effect of sodium-glucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus. Circulation. 2014; 129: 587-597. doi: 10.1161/CIRCULATIONAHA.113.005081

Katsuno K, Fujimori Y, Takemura Y, et al. Sergliflozin, a novel selective inhibitor of low-affinity sodium glucose reab-sorption and modulates plasma glucose level. J Pharmacol Exp Ther. 2007; 320: 323-330. doi: 10.1124/jpet.106.110296

Lin B, Koibuchi N, Hasegawa Y, et al. Glycemic control with empagliflozin, a novel selective SGLT2 inhibitor, ameliorates cardiovascular injury and cognitive dysfunction in obese and type 2 diabetic mice. Cardiovasc Diabetol. 2014; 13: 148. doi: 10.1186/s12933-014-0148-1

List JF, Woo V, Morales E, Tang W, Fiedorek FT. Sodium-glucose cotransport inhibition with dapagliflozin in type 2 diabe-tes. Diabetes Care. 2009; 32: 650-657. doi: 10.2337/dc08-1863

Haas B, Eckstein N, Pfeifer V, Mayer P, Hass MDS. Effi-cacy, safety and regulatory status of SGLT2 inhibitors: focus on canagliflozin. Nutr Diabetes. 2014; 4: e143. doi: 10.1038/ nutd.2014.40

Shawkat H, Westwood MM, Mortimer A. Mannitol: a review of its clinical uses. Contin Educ Anaesth Crit Care Pain. 2012; 12(2): 82-85. doi: 10.1093/bjaceaccp/mkr063

Bernstein LM, Blumberg B, Arkin MC. Osmotic diuretic treatment of refractory edema. Circulation. 1958; 17; 1013- 1020. doi: 10.1161/01.CIR.17.6.1013

Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centered approach. Update to a position statement of the American Dia-betes Association and the European Association for the Study of Diabetes. Diabetologia. 2015; 58: 429-442.

Warshaw HS, Bolderman KM. Practical carbohydrate count-ing. 2nd ed. Alexandria, VA: American Diabetes Association. 2008.

Aoki Y, Onzuka M. Glycemic variations after ingestion of different carbohydrate-containing foods assessed by continuous glucose monitoring in healthy and diabetic individuals in daily life. Diabetes Res Open J. 2015; 1(2): 41-47.

Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2013; 36: 3821-3842. doi: 10.2337/dc13-2042

Feinman RD, Pogozelski WK, Astrup A, A et al. Dietary carbohydrate restriction as the first approach in diabetes man-agement: critical review and evidence base. Nutrition. 2015; 31: 1-13. doi: 10.1016/j.nut.2014.06.011

Perkins BA, Cherney DZI, Partridge H, et al. Sodium-glu-cose cotransporter 2 inhibition and glycemic control in type 1 diabetes: results of an 8-week open-label proof-of-concept trial. Diabetes Care. 2014; 37: 1480-1483. doi: 10.2337/dc13-2338 Diabetes Res Open J

Downloads

Published

2015-07-01

How to Cite

Yuji Aoki. (2015). 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. Diabetes Research, 1(3), 72–74. https://doi.org/10.17140/DROJ-1-111

Issue

Vol. 1 No. 3 (2015): Volume 1 Issue 3 2015

Section

Articles

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

All content published in Diabetes Research (DR) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.