Impact of sodium-glucose cotransporter-2 inhibitors on kidney outcomes in type 2 diabetes: A tertiary center experience

BACKGROUND

Diabetic nephropathy (DN) is a complication of chronic hyperglycemia associated with diabetes mellitus (DM). Several studies have demonstrated the positive impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors on kidney outcomes. The objective of the study was to evaluate the effects of dapagliflozin, an SGLT2 inhibitor, on kidney outcomes in Saudi patients with type 2 DM.

MATERIALS AND METHODS

Study included all Saudi patients with type 2 DM who visited our center from August 1, 2021, to July 31, 2022, and had been on dapagliflozin for at least 3 months. Data was abstracted through chart review for all patients included in the study. Paired t-test or Wilcoxon signed-rank test were used to compare the results before and after treatment for continuous variables and the McNemar test was used to compare the results for categorical data.

RESULTS

Study included 184 Saudi patients with type 2 diabetes with a mean age of 61.32 years (SD=9.37). Dapagliflozin 10 mg/day significantly reduced hemoglobin A1C (HbA1C) from a mean (SD) of 9.00 to 8.40 (P < 0.001). Among a subgroup of patients with significant proteinuria (n = 83), dapagliflozin significantly reduced ACR from a median of 93.1 to 64.9 mg/g (P = 0.001). Following treatment, the estimated glomerular filtration rate improved from a mean of 69.83 to 71.68 mL/min and the mean arterial pressure (MAP) fell from 90.03 to 89.06 mmHg, both were not statistically significant. Despite a statistically insignificant increase in the episodes of urinary tract infections (UTIs), the hospitalization rate declined. No episodes of amputations or ketoacidosis occurred during the study period.

CONCLUSION

SGLT2 inhibitors had beneficial effects among Saudi patients with type 2 diabetes by improving diabetic control and lowering proteinuria. Dapagliflozin did not result in significant harm, including UTIs, amputations, and ketoacidosis.

Recurrent Adipsic Hypernatremia in a Fully Independent Non-psychiatric Patient With Multiple Congenital Anomalies: A Case Report

Osmoregulation is a fundamental process of homeostasis that maintains metabolic and biochemical reactions, thermoregulation, and fluid-electrolytes balance. Fluid-electrolytes imbalance leads to various clinical manifestations ranging from mild weakness to severe neurological dysfunction. Adipsic hypernatremia is an exceedingly rare life-threatening condition characterized by defective osmoregulatory mechanisms. It is more often reported in patients with severe untreated psychiatric disorders for unknown etiologies, but it may result from congenital or acquired hypothalamic lesions in the form of stroke, neoplastic infiltration, trauma, or infection. Herein we report an unusual case of isolated hypernatremia in a fully independent non-psychiatric 27-year-old diabetic male with spina bifida, repaired cleft palate, and mild caudal regression syndrome.

Hypothyroidism and the risk of coronary artery disease in Saudi patients

BACKGROUND

Hypothyroidism has been described in the literature as a risk factor for coronary artery disease (CAD). An association between thyroid-stimulating hormone (TSH) levels and CAD has been confirmed. In Saudi Arabia, there has been no study on the relationship between hypothyroidism and CAD. Therefore, the aim of this study was to investigate the prevalence and risk factors of CAD in patients with hypothyroidism.

MATERIALS AND METHODS

This cross-sectional study conducted at King Abdulaziz Medical City in Riyadh (KAMC-R), included 412 adult hypothyroid patients who were followed up between 2013 and 2018. The data was collected on demographics, CAD-related risk factors, and hypothyroidism. In addition, relevant laboratory tests, including thyroid function tests, lipid profile, and hemoglobin A1c, were collected. SPSS version 28.0 was used for data analysis. Categorical data were presented as frequencies and percentages, while mean and standard deviations were computed for the numerical data. Student's t-test used to test statistical significance for numerical variables and Chi- square test was performed to test the differences between categorical variables. Multivariate binary logistic regression was used to determine the effects of gender, BMI, family history (CAD), smoking, hypertension, and TSH on CAD.

RESULTS

Of the 412 hypothyroid patients, 21.8% were diagnosed with CAD, with more prevalence in men (44.15%) than in women (15.4%). About 46% had hypertension, 2.2% were smokers, and 2.4% had family history of CAD. Older age was significantly associated with a higher prevalence of CAD compared to younger age groups. The mean of TSH was significantly higher in CAD patients than non-CAD patients before and at diagnosis with CAD (P < 0.001). For every 1mIU/L increase in the TSH level, the odds of developing CAD increased significantly by 4.8% (P = 0.014). The odds ratios for other CAD risk factors were 3.13 for males, 8.1 for smoking, 2.48 for hypertension, and 9.9 for family history of CAD (P < 0.05).

CONCLUSION

The prevalence of CAD in hypothyroid patients was higher than in the general population. TSH level was significantly associated with CAD. Male gender, older age, smoking, hypertension, family history of CAD, and high TSH level increased the likelihood of developing CAD.