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

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.