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The Diabetes Medications Linked with Ketoacidosis

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While type 2 diabetes is a debilitating disease, there are treatments available for the condition. From dietary changes and exercise routines to natural supplements and prescription medications, there are many options available to help limit the damage caused by diabetes. However, new research has revealed that one particularly common class of diabetes drugs may cause serious side effects that are causing many doctors to rethinking how they treat the disease.

When you develop type 2 diabetes, the body attempts to dispel excess blood sugar out through the urine. However, the kidneys typically reabsorb much of this glucose and send it back to the bloodstream. In 2013, drugs known as SGLT2 inhibitors were introduced to counteract this action by limiting reabsorption of glucose in the kidneys. Through this mechanism of action, SGLT2 inhibitors have been shown to lower A1C levels by 0.7% to 1%. In addition, this class of medication has proven exceedingly popular due to the weight loss it can produce.

Despite their initial promise, just 2 years after their approval for use by the public, studies emerged linking these drugs to the development of ketoacidosis, a dangerous condition that is most often seen in type 1 diabetics. Ketoacidosis occurs when your body does not have enough insulin to metabolize your blood sugar and can be life threatening if not immediately treated. For this reason, the FDA required a warning label on all SGLT2 inhibitors disclosing the potential risk of developing ketoacidosis.

Unfortunately, recent research has further heightened alarm over this particular class of medication. According to a new study of more than 200,000 people with type 2 diabetes, those taking SGLT2 inhibitors were 3 times more likely to develop ketoacidosis compared to another group taking a different diabetes drug. Perhaps even more concerning, the researchers suggested that the incidence of ketoacidosis may have been underreported, as doctors do not typically monitor individuals with type 2 diabetes for ketoacidosis because it is normally associated with type 1 diabetes. As such, the true risk of developing this dangerous side effect may be even higher than the data indicated.

Despite these significant warning signs, SGLT2 inhibitors remain approved by the FDA, prescribed to over 1.7 million people in 2017 alone. If you currently take SGLT2 inhibitors, talk with your doctor about the benefits and risks associated with the medication.

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Paul

Paul has been interested in medical research since his first organic chemistry class in college. He was a high school biology teacher for 32 years until retiring to spend more time reading, hiking, and camping with his wife and two dogs.

References

  1. Taylor SI, Blau JE, Rother KI. SGLT2 Inhibitors May Predispose to Ketoacidosis. J Clin Endocrinol Metab. 2015 Aug;100(8):2849-52. doi: 10.1210/jc.2015-1884. Epub 2015 Jun 18. PMID: 26086329; PMCID: PMC4525004.
  2. Nasa P, Chaudhary S, Shrivastava PK, Singh A. Euglycemic diabetic ketoacidosis: A missed diagnosis. World J Diabetes. 2021 May 15;12(5):514-523. doi: 10.4239/wjd.v12.i5.514. PMID: 33995841; PMCID: PMC8107974.
  3. Blau JE, Tella SH, Taylor SI, Rother KI. Ketoacidosis associated with SGLT2 inhibitor treatment: Analysis of FAERS data. Diabetes Metab Res Rev. 2017 Nov;33(8):10.
    1002/dmrr.2924. doi: 10.1002/dmrr.2924. Epub 2017 Sep 29. PMID: 28736981; PMCID: PMC5950709.