Sglt2 Inhibitors Continue To Be Linked With Amputation Risk In Type 2 Diabetes

[DCUK NewsBot]

Research has again linked the drug class sodium-glucose co-transporter-2 (SGLT2) inhibitors to an increased risk of amputation in people with type 2 diabetes. SGLT2 inhibitors help to lower the blood sugar of people with type 2 diabetes by assisting the kidneys in excreting urine. But links to a higher risk of amputation have been recognised in recent years. The European Medicines Agency and US Food and Drug Administration (FDA) both determined in 2017 that SGLT2 drug boxes should carry a warning stating an increased risk of lower-limb amputation. Research continues to investigate the link, and this new study by Johns Hopkins Bloomberg School of Public Health researchers, in the US, again revealed higher amputation risks with the drug class. When compared with adults with type 2 diabetes who took either sulphonylureas, metformin and glitazones, new users of SGLT2 drugs had twice the risk of undergoing lower extremity amputation. This was deemed to be statistically significant after accounting for a number of factors such as severity of diabetes and other health conditions present. The data from 953,906 participants also revealed that new users of SGLT2 inhibitors had a higher risk of amputation than new users of DDP-4 inhibitors and GLP-1 agonists, although these findings were not statistically significant. "Given the uncertainty regarding the true nature of the association between SLGT-2 inhibitors and amputation, clinicians and patients will have to navigate treatment choices while balancing the potential risks of these products against their benefits and alternatives," said the study authors. Benedict Jephcote, Editor of Diabetes.co.uk, commented on the findings, "The reason for the higher risk of amputations has not been fully investigated by research. However, the way in which SGLT2 inhibitors work may offer some clues. "We know that the drugs help the body to pass glucose out through the urine when sugar levels are too high. Whilst this helps to keep sugar levels under a high level, this level may still be high enough to increase the spread of infection at the site of a wound and thus increase the risk of amputation being needed. "This provides a possible reason but, at the moment, we cannot confirm if this is factor in the increase in amputation or not." Last month a tool was introduced that could help healthcare professionals determine which people with type 2 diabetes would benefit most from SGLT2 treatment. The findings have been published in JAMA Internal Medicine.

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[ickihun]

I found I still suffered thrush which is only experienced by me when my bgs sit in a bracket of where neuropathy can develop too. Over 7.8mmol/l on my meter but meter would show 5s or 6s.
So i conclude that circulated blood (oxygenated blood) get glucose cleared by kidneys by these drugs but deoxygenised blood is higher in glucose and often stagnant in the legs and feet in resting diabetics. Blood not circulating properly is dangerous in even none diabetics. Stale blood roits.
To prevent this exercise and possible flight stockings or similiar.

These drugs only work in oxygenised blood.
What about the deoxygenised blood? It's of higher glucose levels... I bet.

 

[Oldvatr]

Abstract:
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2696730

Study Report:
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2696726

Also this may be of interest to anyone taking these drugs regarding mortality:
https://jamanetwork.com/journals/ja...t=personalizedcontent&previousarticle=2696726

Edit to add: I have now added these studies to the sticky post for this group of medicines.

 

[kokhongw]

Relying on medication to remove excess glucose from our system may not be as safe in the long run after all...why not just have less carbs...

 

[Oldvatr]

Do I read that right? HbA1c reduction of 0.5 to 0.9% is pitiful. That is less than 1 mmol/mol or 1 mg/dl in 100.

Anyway that is what it says on the tin, but I am not so sure it is living up to these expectations. My hype detector is working overtime here. I am not so sure there are reliable studies that support these claims.

 

[ickihun]

Relying on medication to remove excess glucose from our system may not be as safe in the long run after all...why not just have less carbs...

Because even doing zero carbs does guarantee me perfect bgs. Its just an additional tool for me.
Too low a carb diet and I get racing heart beats and chest pains. Dizziness and weakness with no energy.
Its not an 100% solution, for me.

I'm doing bariatric surgery so I can lose weight which SHOULD help with my severe insulin resistance which low carb reduces glucose spikes but no cure for IR, well not for me.
Weight loss in the guaranteed researched effective way and no maybe. Only how much is the variant. How much weight loss and how much IR is reduced (in use of less insulin units).
I will endeavour to use low carb in my weight maintenence once I've lost bulk of the weight, they expect.
Less insulin units, less intake and less carbs should be the winning combination for reversal or close to it. Supplementing as all other patients have before me have done. The tried and tested way to lose with surgery will be adhered to, first and foremost. Low carb will only be introduced after the peak of loss is over.
Dietician allows 20g carb per meal currently.