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San Juan Galán J, Poliquin V, Gerstein AC. Insights and advances in recurrent vulvovaginal candidiasis. PLoS Pathog 2023; 19:e1011684. [PMID: 37948448 PMCID: PMC10637712 DOI: 10.1371/journal.ppat.1011684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Javier San Juan Galán
- Department of Microbiology, Faculty of Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vanessa Poliquin
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aleeza Cara Gerstein
- Department of Microbiology, Faculty of Science, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Statistics, Faculty of Science, University of Manitoba, Winnipeg, Manitoba, Canada
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2
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Becker M, Sobel R. Vulvovaginal Candidiasis in Postmenopausal Women. Curr Infect Dis Rep 2023. [DOI: 10.1007/s11908-023-00801-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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3
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O’Laughlin DJ, McCoy RG. Diabetes and Vulvovaginal Conditions. Clin Diabetes 2023; 41:458-464. [PMID: 37456089 PMCID: PMC10338276 DOI: 10.2337/cd23-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Danielle J. O’Laughlin
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN
| | - Rozalina G. McCoy
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN
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Forman JL, Mercurio MG. Vulvar Pruritus in Postmenopausal Diabetic Women With Candidiasis Secondary to Sodium-Glucose Cotransporter Receptor-2 Inhibitors. J Low Genit Tract Dis 2023; 27:68-70. [PMID: 36129363 DOI: 10.1097/lgt.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jessica L Forman
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY
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Mounsey SJ, Teo YX, Calonje JE, Lewis FM. Gliflozin (SGLT2 inhibitor) induced vulvitis. Int J Dermatol 2022; 62:62-65. [PMID: 36250299 DOI: 10.1111/ijd.16449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/22/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Sodium-glucose co-transporter 2 (SGLT2) inhibitors, or gliflozins, are used as mono or combined therapy in the management of diabetes. Genital infections are the most common reported adverse effect, as a result of induced glycosuria. Cutaneous features of patients experiencing vulval symptoms while on SGLT2 inhibitor therapy have not been clearly described in published literature. We have observed a specific inflammatory vulvitis with psoriasiform features in patients taking SGLT2 inhibitors, related to candidiasis in most cases. METHODS AND RESULTS Demographic and treatment outcomes of 11 patients with characteristic inflammatory changes after starting SGLT2 inhibitors were extracted from electronic records. Ninety-one percent (n = 10) had candidiasis, treated with fluconazole. Six (54.5%) were able to continue SGLT-2 inhibitors through the addition of topical treatments, but five patients had to discontinue the drug. CONCLUSIONS SGLT2 inhibitors can result in characteristic inflammatory vulvitis. Treatment with topical agents and single-dose antifungals may allow patients to continue their therapy to achieve improved glycemic control. In resistant cases, discontinuation of the drug is necessary. We highlight this effect so that early treatment can be initiated to alleviate symptoms and recognition of underlying cause.
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Affiliation(s)
- Stephen J Mounsey
- St. John's Institute of Dermatology, Guy's and St. Thomas's NHS Foundation Trust, London, UK
| | - Ying X Teo
- St. John's Institute of Dermatology, Guy's and St. Thomas's NHS Foundation Trust, London, UK
| | - Jaime E Calonje
- St. John's Institute of Dermatology, Guy's and St. Thomas's NHS Foundation Trust, London, UK
| | - Fiona Mary Lewis
- St. John's Institute of Dermatology, Guy's and St. Thomas's NHS Foundation Trust, London, UK
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Talapko J, Meštrović T, Škrlec I. Growing importance of urogenital candidiasis in individuals with diabetes: A narrative review. World J Diabetes 2022; 13:809-821. [PMID: 36311997 PMCID: PMC9606786 DOI: 10.4239/wjd.v13.i10.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/06/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
Both diabetes and fungal infections contribute significantly to the global disease burden, with increasing trends seen in most developed and developing countries during recent decades. This is reflected in urogenital infections caused by Candida species that are becoming ever more pervasive in diabetic patients, particularly those that present with unsatisfactory glycemic control. In addition, a relatively new group of anti-hyperglycemic drugs, known as sodium glucose cotransporter 2 inhibitors, has been linked with an increased risk for colonization of the urogenital region with Candida spp., which can subsequently lead to an infectious process. In this review paper, we have highlighted notable virulence factors of Candida species (with an emphasis on Candida albicans) and shown how the interplay of many pathophysiological factors can give rise to vulvovaginal candidiasis, potentially complicated with recurrences and dire pregnancy outcomes. We have also addressed an increased risk of candiduria and urinary tract infections caused by species of Candida in females and males with diabetes, further highlighting possible complications such as emphysematous cystitis as well as the risk for the development of balanitis and balanoposthitis in (primarily uncircumcised) males. With a steadily increasing global burden of diabetes, urogenital mycotic infections will undoubtedly become more prevalent in the future; hence, there is a need for an evidence-based approach from both clinical and public health perspectives.
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Affiliation(s)
- Jasminka Talapko
- Laboratory for Microbiology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Tomislav Meštrović
- University North, University Centre Varaždin, Varaždin 42000, Croatia
- Institute for Health Metrics and Evaluation, Department for Health Metrics Sciences, University of Washington School of Medicine, Seattle, Washington 98195, United States
| | - Ivana Škrlec
- Department of Biophysics, Biology, and Chemistry, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
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Sugimoto N, Yamagishi Y, Mikamo H. Effect of Empagliflozin on <i>Candida glabrata</i> Adhesion to Vaginal Epithelial Cells. Med Mycol J 2022; 63:43-47. [DOI: 10.3314/mmj.21-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Naomi Sugimoto
- Department of Clinical Infectious Diseases, Aichi Medical University School of Medicine
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University School of Medicine
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University School of Medicine
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8
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Halimi JM. [SGLT2 inhibitors: A new era for our patients]. Nephrol Ther 2021; 17:143-148. [PMID: 33773943 DOI: 10.1016/j.nephro.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
Since 2015, 10 randomized clinical trials assessed the cardiovascular safety of SGLT2 inhibitors, and then assessed the potential renal and cardiovascular benefits of these drugs (EMPAREG Outcome, CANVAS, DECLARE, DAPA-HF, CREDENCE, EMPEROR-reduced, VERTIS, DAPA-CKD, SCORED, SOLOIST-WHF) in over 88,000 patients. The results of EMPAREG Outcome showed major renal and cardiovascular protection but they were unexpected. The other trials regarding the effects of dapagliflozin, canagliflozin, empagliflozin and more recently sotagliflozin have confirmed most of these results and extended them to other populations. There is no scientific doubt that these drugs confer a marked renal protection in patients already treated with renin angiotensin system blockers (reduction of the risk of end-stage renal disease: -35 to 40%) et reduce the risk of hospitalization for heart failure (-30 to 35%), especially in patients with heart failure with reduced ejection fraction. The benefit/risk profile is highly favorable but minor (genital candidosis, urinary tract infections, euglycemic acido-ketosis) and serious (Fournier gangrene) side effects must not be forgotten. Renal protection is twice the effect of renin angiotensin system blockers, and is maintained in patients already treated with them, in patients with GFR 25mL/min/1.73m2 and over, regardless of whether they have type 2 diabetes mellitus or not (of note, patients with type 1 diabetes mellitus, polycystic kidney disease, lupus and vasculitis were excluded in these studies). Reduction of the incidence of heart failure is similar to that observed with sacubitril/valsartan, and is maintained in patients already treated with sacubitril/valsartan. SGLT2 inhibitors have now defined a new standard of care, and it will be necessary to explore the proper use of the new mineralocorticoid receptor antagonist finerenone that demonstrated significant renal and cardiovascular protection in mostly SGLT2 inhibitors-untreated diabetic patients with chronic kidney disease (or even some GLP-1 agonists). A new era for our patients.
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Affiliation(s)
- Jean-Michel Halimi
- Service de néphrologie-HTA, dialyses et transplantation rénale, hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France.
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Marques LPJ, Mendonça NA, Müller L, André ACPD, Madeira EPQ, Vieira LMSF. Impact of sodium-glucose cotransporter-2 inhibitors-induced glucosuria in the incidence of urogenital infection on postmenopausal women with diabetes. Postgrad Med 2020; 132:697-701. [DOI: 10.1080/00325481.2020.1816360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Luiz Paulo José Marques
- Renal Unit of Gaffrée and Guinle University Hospital - Department of Medicine, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Nayanne Aguiar Mendonça
- Renal Unit of Gaffrée and Guinle University Hospital - Department of Medicine, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Lucas Müller
- Renal Unit of Gaffrée and Guinle University Hospital - Department of Medicine, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Ana Carolina Pereira Diaz André
- Renal Unit of Gaffrée and Guinle University Hospital - Department of Medicine, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Eugênio Pacelle Queiroz Madeira
- Renal Unit of Gaffrée and Guinle University Hospital - Department of Medicine, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Lygia Maria Soares Fernandes Vieira
- Renal Unit of Gaffrée and Guinle University Hospital - Department of Medicine, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
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Nieto-Benito LM, Barchino-Ortiz L. Increased risk of vulvovaginal candidiasis in diabetic patients under treatment with SGLT2 inhibitors. Med Clin (Barc) 2020; 157:39-40. [PMID: 32819773 DOI: 10.1016/j.medcli.2020.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022]
Affiliation(s)
| | - Lucía Barchino-Ortiz
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Candida sepsis from local infection in a patient with a urostomy on SGLT2 inhibitor therapy. Int J Infect Dis 2020; 98:227-229. [PMID: 32592907 DOI: 10.1016/j.ijid.2020.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 11/21/2022] Open
Abstract
Sodium-glucose co-transporter 2 (SGLT2) inhibitors exhibit impressive cardio-renal benefits in patients with a high cardiovascular risk. Genital yeast infections are important side effects of this class of drugs. We report a case of Candida glabrata sepsis secondary to a Candida infection of the urostomy of a patient on SGLT2 inhibitor therapy. In urostomy patients, one should critically evaluate the risk of mycotic infections against the cardiovascular and glycaemic benefits of SGLT2 inhibition. Urostomy patients without a high cardiovascular risk should not be treated with SGLT2 inhibitors.
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Yokoyama H. Incidence of severe urinary tract infections not increased by initiating sodium-glucose cotransporter 2 inhibitors. J Diabetes Investig 2020; 11:530-531. [PMID: 31763787 PMCID: PMC7232355 DOI: 10.1111/jdi.13189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 01/25/2023] Open
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Huang J, Xiong S, Ding S, Cheng Q, Liu Z. Safety of Ertugliflozin in Patients with Type 2 Diabetes Mellitus Inadequately Controlled with Conventional Therapy at Different Periods: A Meta-Analysis of Randomized Controlled Trials. J Diabetes Res 2020; 2020:9704659. [PMID: 33532502 PMCID: PMC7831274 DOI: 10.1155/2020/9704659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/25/2020] [Accepted: 12/05/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS To assess the safety of ertugliflozin in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with conventional therapy at different periods. METHODS We searched PubMed, Embase, and The Cochrane Library from inception to September 23, 2020. A total of six studies involving 4120 patients were included. RESULTS Compared with the control group, 15 mg and 5 mg of ertugliflozin were associated with higher risks of genital mycotic infections (GMIs) at 26 weeks (p < 0.0001 and p < 0.0001, respectively), 52 weeks (p < 0.00001 and p < 0.0001, respectively), and 104 weeks (p < 0.00001 and p < 0.0001, respectively). Moreover, females had a higher risk of GMIs than males in the 15 mg group at 26 weeks (p = 0.0008), 52 weeks (p < 0.0001), and 104 weeks (p = 0.02). At 104 weeks, 15 mg and 5 mg of ertugliflozin showed beneficial effects on symptomatic hypoglycemia (p < 0.00001 and p = 0.004, respectively) compared with the effects observed in the control group. Compared with the control group, 15 mg and 5 mg of ertugliflozin were associated with higher risks of drug-related adverse events at 26 weeks (p = 0.002 and p = 0.002, respectively); 15 mg of ertugliflozin was associated with a higher risk of discontinuation related to adverse events at 104 weeks (p = 0.03). No significant differences were found in the remaining safety outcomes. CONCLUSION This meta-analysis of randomized controlled trials indicates that ertugliflozin is tolerated by T2DM, but the risk of GMIs is noteworthy, especially among females in the high-dose group.
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Affiliation(s)
- Jing Huang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shuyuan Xiong
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shenglan Ding
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qingfeng Cheng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhiping Liu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Fujita Y, Inagaki N. Update on the efficacy and safety of sodium-glucose cotransporter 2 inhibitors in Asians and non-Asians. J Diabetes Investig 2019; 10:1408-1410. [PMID: 31541588 PMCID: PMC6825932 DOI: 10.1111/jdi.13150] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/24/2022] Open
Abstract
Benefits and risks of SGLT2 inhibitor use.![]()
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Affiliation(s)
- Yoshihito Fujita
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Candida sp. Infections in Patients with Diabetes Mellitus. J Clin Med 2019; 8:jcm8010076. [PMID: 30634716 PMCID: PMC6352194 DOI: 10.3390/jcm8010076] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 12/27/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023] Open
Abstract
Candidiasis has increased substantially worldwide over recent decades and is a significant cause of morbidity and mortality, especially among critically ill patients. Diabetes mellitus (DM) is a metabolic disorder that predisposes individuals to fungal infections, including those related to Candida sp., due to a immunosuppressive effect on the patient. This review aims to discuss the latest studies regarding the occurrence of candidiasis on DM patients and the pathophysiology and etiology associated with these co-morbidities. A comprehensive review of the literature was undertaken. PubMed, Scopus, Elsevier’s ScienceDirect, and Springer’s SpringerLink databases were searched using well-defined search terms. Predefined inclusion and exclusion criteria were applied to classify relevant manuscripts. Results of the review show that DM patients have an increased susceptibility to Candida sp. infections which aggravates in the cases of uncontrolled hyperglycemia. The conclusion is that, for these patients, the hospitalization periods have increased and are commonly associated with the prolonged use of indwelling medical devices, which also increase the costs associated with disease management.
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Mirabelli M, Chiefari E, Caroleo P, Vero R, Brunetti FS, Corigliano DM, Arcidiacono B, Foti DP, Puccio L, Brunetti A. Long-Term Effectiveness and Safety of SGLT-2 Inhibitors in an Italian Cohort of Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2019; 2019:3971060. [PMID: 31781664 PMCID: PMC6875368 DOI: 10.1155/2019/3971060] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND SGLT-2 (sodium-glucose cotransporter-2) inhibitors are a novel class of oral hypoglycemic agents for the management of type 2 diabetes mellitus (T2DM). Herein, we aimed to assess the long-term effectiveness and safety of SGLT-2 inhibitors in a Southern Italy population of subjects affected by T2DM. PATIENTS AND METHODS 408 diabetic patients treated with one of the three SGLT-2 inhibitors currently available in Italy (dapagliflozin, empagliflozin, and canagliflozin), either alone or in combination with other antidiabetic drugs, were retrospectively assessed at baseline, during, and after 18 months of continuous therapy. RESULTS Treatment with SGLT-2 inhibitors resulted in a median decrease in HbA1c of 0.9%, with a percentage of decrement of 12 in relation to the baseline value, followed by a significant reduction (P < 0.001) in fasting plasma glucose. Variations in HbA1c occurred independently of the baseline clinical or biochemical characteristics. In addition, treatment with SGLT-2 inhibitors reduced body weight (P < 0.008) and decreased diastolic blood pressure (P = 0.004). With regard to safety outcomes, 66 patients out of 91 stopped SGLT-2 inhibitors during follow-up because of chronic or recurring genital infections, while the rest experienced other adverse events, such as urinary tract infections, polyuria, nausea, hypotension, dizziness, acute coronary event, worsening of glycemic control status, and rapid deterioration of renal function. CONCLUSION In our patients' population, the glycometabolic effects of SGLT-2 inhibitors were durable and comparable to those observed in multicenter randomized controlled trials. This notwithstanding safety concerns must be raised regarding the frequent occurrence of genitourinary infections and the risk of a rapid decline of renal function in patients with evidence of volume depletion and/or receiving other medications which can adversely affect kidney function.
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Affiliation(s)
- Maria Mirabelli
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
| | - Eusebio Chiefari
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
| | - Patrizia Caroleo
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, Catanzaro, Italy
| | - Raffaella Vero
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, Catanzaro, Italy
| | | | | | - Biagio Arcidiacono
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
| | - Daniela Patrizia Foti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
| | - Luigi Puccio
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
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