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During the past several years, several new classes of diabetic medications were introduced for clinical use, including SGLT2 inhibitors (canagliflozin, dapagliflozin and empagliflozin).
SGLT2 inhibitors prevent reabsorption of glucose in the proximal convoluted tubules in the kidney and does not alter insulin release.
A recent retrospective study (n=88) of 13 poison center data from January 2013 to December 2016 showed
- 91% of the patients were asymptomatic.
- 7% developed minor symptoms (tachycardia, nausea/vomiting, abdominal pain, & confusion)
- 2% developed moderate symptoms (metabolic acidosis, hypertension [166/101], & hypokalemia)
- Hypoglycemia was not reported.
49 patients were evaluated in a health care facility (HCF) with 18 admissions. Referral to HCF was more common in pediatric patients. This was likely due to unfamiliarity with a new mediation and lack of toxicity data.
Other case reports have shown higher incidence of DKA with the therapeutic use of SGLT2 vs. other classes of DM medications.
Bottom line:
Limit data is available regarding the toxicologic profile of SGLT2 inhibitors.
Based upon this small retrospective study, hypoglycemia may not occur and majority of the patient experience minimal symptoms.
References
Schaeffer SE et al. Retrospective review of SGLT2 inhibitor exposures reported to 13 poison center. Clin Toxicol (Phila).2017 Aug 16:1-5 PMID: 28812381
Burke KR et al. SGLT2 inhibitors: a systematic review of diabetic ketoacidosis and related risk factors in the primary literature. Pharmacothearpy. 2017;37:187-194