SGLT2 Inhibitors, What the Emergency Physician Needs to Know: A Narrative Review - Lu, H.; Lu, H.; Kosinski, C.; Wojtusciszyn, A.; Zanchi, A.; Carron, P. N.; Muller, M.; Meyer, P.; Martin, J.; Muller, O.; Hullin, R. (J Clin Med, 2021)
Canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin belong to a class of antidiabetic treatments referred to as sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors, or SGLT2is). SGLT2is are currently indicated in North America and in Europe in type 2 diabetes mellitus, especially in patients with cardiovascular (CV) disease, high CV risk, heart failure, or renal disease. In Europe, dapagliflozin is also approved as an adjunct to insulin in patients with type 1 diabetes mellitus. New data provide evidence for benefits in heart failure with reduced ejection fraction and chronic kidney disease, including in patients without diabetes. The use of SGLT2is is expected to increase, suggesting that a growing number of patients will present to the emergency departments with these drugs. Most common adverse events are easily treatable, including mild genitourinary infections and conditions related to volume depletion. However, attention must be paid to some potentially serious adverse events, such as hypoglycemia (when combined with insulin or insulin secretagogues), lower limb ischemia, and diabetic ketoacidosis. We provide an up-to-date practical guide highlighting important elements on the adverse effects of SGLT2is and their handling in some frequently encountered clinical situations such as acute heart failure and decompensated diabetes.
Keywords: journalArticle; Cardiology Service of the University Hospitals of Geneva (GeCor foundation). The; Mundipharma. A.Z. also participated in clinical trials for Boehringer Ingelheim; P.M. has participated to meetings organized by Boehringer Ingelheim, whose; consulting honoraria from Boehringer Ingelheim, Astra Zeneca and Janssen. A.Z.; diabetes; funders had no role in the writing or in the decision to publish the manuscript; guidelines; heart failure; honoraria have been entirely paid to a private research foundation of the; not have any conflict of interest in relation with this article. A.W. reports; renal; reports consulting honoraria from Boehringer Ingelheim, Astra Zeneca and