Department of Diabetes and Endocrinology, Yodogawa Christian Hospital, Osaka, Japan.
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Kobe J Med Sci. 2024 Jul 25;70(3):E81-E88. doi: 10.24546/0100490464.
The prescription of sodium-glucose cotransporter-2 (SGLT2) inhibitors have been increasing due to their additional benefits, including weight loss, cardioprotection and renoprotection. Accordingly, there are concerns about the potential rise in severe adverse drug reactions (ADRs), such as urinary tract infections, diabetic ketoacidosis, volume depletion, and hypoglycemia. The Society has announced recommendations on the proper use of SGLT2 inhibitors. We aimed to elucidate the recent occurrence of severe ADRs which need discontinuation of SGLT2 inhibitors or hospitalization.
In this retrospective cohort study, we identified 391 diabetic patients who were prescribed SGLT2 inhibitors upon admission to our hospital between April 2017 and March 2023. Of these, 68 patients who discontinued SGLT2 inhibitors for reasons other than ADRs were excluded. Patients were classified into the 2017 group and the 2020 group based on the treatment period of SGLT2 inhibitors, and the occurrence of ADRs and patient backgrounds were compared between the two groups.
A total of 323 eligible patients were identified. Discontinuations of SGLT2 inhibitors decreased in the 2020 group ( < 0.05). However, discontinuations due to frailty increased ( < 0.05). Hospitalization due to ADRs, specifically those due to urinary tract infections, diabetic ketoacidosis, or volume depletion, did not specifically decrease ( = 0.273).
This study indicated that there has been some improvement in the awareness of the proper use of SGLT2 inhibitors and there is still a need to continue enlightenment activities.
由于钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂具有额外的益处，包括体重减轻、心脏保护和肾脏保护，因此其处方量不断增加。相应地，人们对其潜在的严重药物不良反应（ADR）的增加有所担忧，如尿路感染、糖尿病酮症酸中毒、容量耗竭和低血糖。该学会已经公布了 SGLT2 抑制剂合理使用的建议。我们旨在阐明最近需要停用 SGLT2 抑制剂或住院治疗的严重 ADR 发生情况。
在这项回顾性队列研究中，我们确定了 2017 年 4 月至 2023 年 3 月期间在我院因糖尿病而首次接受 SGLT2 抑制剂治疗的 391 名患者。其中，排除了因 ADR 以外的原因停用 SGLT2 抑制剂的 68 名患者。根据 SGLT2 抑制剂的治疗期，将患者分为 2017 组和 2020 组，并比较两组患者 ADR 的发生情况和患者背景。
共确定了 323 名符合条件的患者。2020 组 SGLT2 抑制剂的停药率有所下降（<0.05）。然而，因虚弱而停药的比例有所增加（<0.05）。因 ADR 住院，特别是因尿路感染、糖尿病酮症酸中毒或容量耗竭而住院的情况并没有明显减少（=0.273）。
本研究表明，人们对 SGLT2 抑制剂合理使用的认识有所提高，但仍需继续开展宣传教育活动。
