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SGLT2 Inhibitors for Diabetes: Benefits, Risks, and How They Work
Introduction: Key Points About SGLT2 Inhibitors
SGLT2 inhibitors are a class of medications primarily used to manage type 2 diabetes by helping the kidneys remove excess sugar from the body through urine. These medications also provide significant heart and kidney benefits, making them a preferred option for certain patients. SGLT2 inhibitors are typically prescribed when other diabetes treatments are not sufficient to control blood sugar levels.
Medications within the SGLT2 Inhibitors Drug Class
Farxiga (Dapagliflozin)
Jardiance (Empagliflozin)
Steglatro (Ertugliflozin)
Invokana (Canagliflozin)
The generic name is the official medical name of the drug, while the brand name is what the medication is marketed as. The generic name is listed in parentheses.
How Do SGLT2 Inhibitors Work? Mechanism of Action
SGLT2 inhibitors work by blocking a protein in the kidneys called sodium-glucose co-transporter 2 (SGLT2), which is responsible for reabsorbing glucose (sugar) back into the bloodstream from urine. By inhibiting this protein, SGLT2 inhibitors allow excess glucose to be excreted through urine, helping to lower blood sugar levels. While all medications in this class function similarly, they may vary slightly in how strongly they block the SGLT2 protein or how long they remain active in the body.
Benefits of SGLT2 Inhibitors for Diabetes and Beyond
SGLT2 inhibitors are primarily used to treat type 2 diabetes, especially when other medications, such as metformin, are not enough to control blood sugar levels. These medications are often favored because they not only help lower blood sugar but also reduce the risk of heart disease and slow the progression of kidney disease. This makes them an excellent option for patients with both diabetes and heart or kidney conditions. If you believe SGLT2 inhibitors might be suitable for you, consider consulting one of our providers through telemedicine for personalized advice.
Potential Side Effects of SGLT2 Inhibitors
Like all medications, SGLT2 inhibitors can cause side effects. While many people tolerate these medications well, it’s important to be aware of potential side effects and discuss any concerns with your healthcare provider before starting treatment. Below is a list of potential side effects, ordered from most common to least common.
Common Side Effects of SGLT2 Inhibitors
Genital yeast infections (10-15%): These infections are more common in women but can also occur in men. Individuals with a history of yeast infections or those who are uncircumcised may be at higher risk.
Urinary tract infections (5-7%): SGLT2 inhibitors increase glucose in the urine, which can promote bacterial growth, leading to urinary tract infections (UTIs). Women and older adults may be at higher risk.
Increased urination (4-6%): Due to the way SGLT2 inhibitors work by removing excess glucose through urine, patients may experience more frequent urination.
Thirst (2-4%): Increased urination can lead to dehydration, causing feelings of excessive thirst.
Low blood pressure (1-3%): SGLT2 inhibitors can cause a drop in blood pressure, especially in people already taking medications for high blood pressure or those who are dehydrated.
Less Common Side Effects of SGLT2 Inhibitors
Ketoacidosis (less than 1%): This is a serious condition where the body produces high levels of blood acids called ketones. It can occur even when blood sugar levels are not very high. Symptoms include nausea, vomiting, abdominal pain, and difficulty breathing. This side effect is more common in people with type 1 diabetes but can also occur in those with type 2 diabetes.
Kidney injury (less than 1%): SGLT2 inhibitors can affect kidney function, particularly in people with pre-existing kidney disease or those taking other medications that impact the kidneys.
Fournier’s gangrene (less than 1%): This is a rare but life-threatening infection of the genital area. Symptoms include pain, swelling, and redness in the genital or perineal area. Immediate medical attention is required if these symptoms occur.
Other side effects that occur in less than 1% of patients include allergic reactions, increased cholesterol levels, back pain, nausea, constipation, dizziness, and fatigue.
It’s important to talk to your healthcare provider about any side effects you experience. Severe side effects, such as ketoacidosis or Fournier’s gangrene, require immediate medical attention. If you have any concerns about starting an SGLT2 inhibitor, our telemedicine providers are available to discuss your options and help you make an informed decision.
Drug-to-Drug Interactions with SGLT2 Inhibitors
SGLT2 inhibitors can interact with other medications, potentially increasing side effects or reducing their effectiveness. Below are some common drug interactions to be mindful of when using SGLT2 inhibitors for diabetes management:
Diuretics (water pills): Combining SGLT2 inhibitors with diuretics may heighten the risk of dehydration and low blood pressure due to increased fluid loss.
Insulin or other diabetes medications: Using SGLT2 inhibitors alongside insulin or sulfonylureas can raise the likelihood of low blood sugar (hypoglycemia). Your doctor may adjust your dosage to help prevent this.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen or naproxen can affect kidney function. When taken with SGLT2 inhibitors, the risk of kidney injury may be elevated.
ACE inhibitors or ARBs: These medications, commonly prescribed for high blood pressure, can also impact kidney function. When used in combination with SGLT2 inhibitors, your doctor may monitor your kidney function more closely.
Always inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements, to avoid potential interactions. If you’re uncertain about a possible interaction, consult one of our telemedicine providers for personalized guidance.
Precautions and Contraindications for SGLT2 Inhibitors
Before starting an SGLT2 inhibitor, certain precautions and contraindications should be considered. This class of diabetes medication may not be suitable for everyone, and your healthcare provider will evaluate your overall health to determine if it’s the right option for you.
Precautions When Using SGLT2 Inhibitors
Kidney function: SGLT2 inhibitors are not recommended for individuals with severe kidney disease or those on dialysis. Your doctor will likely assess your kidney function before starting the medication and continue to monitor it throughout treatment.
Dehydration: SGLT2 inhibitors increase urination, which can lead to dehydration, particularly in older adults or those taking diuretics. Staying well-hydrated is crucial while on this medication.
History of yeast infections: If you have a history of frequent genital yeast infections, you may be at a higher risk of developing this side effect while taking SGLT2 inhibitors.
Low blood pressure: Individuals prone to low blood pressure or those taking medications to lower blood pressure should exercise caution, as SGLT2 inhibitors can cause further drops in blood pressure.
Contraindications for SGLT2 Inhibitors
Type 1 diabetes: SGLT2 inhibitors are not approved for individuals with type 1 diabetes due to the increased risk of diabetic ketoacidosis.
Severe kidney disease: People with advanced kidney disease or those on dialysis should not take SGLT2 inhibitors, as the medication may not be effective and could worsen kidney function.
Allergic reactions: If you have experienced an allergic reaction to an SGLT2 inhibitor in the past, you should avoid taking this medication again.
It’s essential to discuss your complete medical history with your healthcare provider before starting an SGLT2 inhibitor. If you have any concerns or questions, our telemedicine providers are available to help you determine if this medication is appropriate for you.
Conclusion: Weighing the Benefits and Risks of SGLT2 Inhibitors
SGLT2 inhibitors are an effective class of medications for managing type 2 diabetes and may also offer additional benefits for heart and kidney health. However, like all medications, they come with potential side effects and risks. It’s important to carefully weigh these benefits and risks with your healthcare provider, especially if you have underlying health conditions or are taking other medications.
If you’re considering starting an SGLT2 inhibitor or have questions about your current treatment plan, our telemedicine providers are here to assist you. Schedule an appointment to discuss your options and receive personalized care from the comfort of your home. Don’t hesitate to reach out for expert advice and support in managing your health.
