Diabetes In Control. A free weekly diabetes newsletter for Medical Professionals. News and information for Medical Professionals.
Letter from the Editor
When I gave up cable TV about 6 months ago, I lost the ability to see all the infomercials that I hated to watch. Last week I was in Atlanta and was flipping through the channels when I saw an infomercial for a new product to prevent and reverse diabetes. Of course this caught my attention, and after about 10 minutes they alluded to the main ingredient being Vitamin D3. This got me wondering if there was any truth to the information they were sharing, so I had our current intern Usif Darwish, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, look into the data available.
He found out some interesting things you might like to review.
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We can make a difference!
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Dave Joffe
Editor-in-chief
TOP STORIES -- Diabetes News and Research
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Did You Know: The Final Word on UTI Risk With SGLT-2 Inhibitors
New research concludes that the risk for severe urinary tract infections (UTIs) among people with type 2 diabetes in the real-world setting using an SGLT-2 inhibitor may be no greater than with other modern anti-diabetes medication. The study, published in Annals of Internal Medicine, reported the outcomes of a population-based, propensity-matched cohort study in which they analyzed data from 235,730 individuals newly prescribed sodium-glucose cotransporter 2 (SGLT-2) inhibitors, dipeptidyl peptidase–4 (DPP-4) inhibitors, and glucagon like peptide–1 receptor (GLP-1) agonists. In the first cohort, comparing SGLT-2 inhibitors with DPP-4 inhibitors, there were no significant differences between the two groups in the incidence rate of severe urinary tract infections (UTIs) (adjusted hazard ratio, 0.98; 95% confidence interval, 0.68-1.41). In the second cohort, which compared patients taking GLP-1 receptor agonists with those taking SGLT-2 inhibitors, researchers saw a slightly lower incidence of severe UTIs among individuals on SGLT-2 inhibitors (HR, 0.72; 95% CI, 0.53-0.99; P = .04). The analysis also failed to find any evidence that SGLT-2 inhibitors were associated with an increase in the risk of hospitalization or outpatient treatment for a UTI. The researchers found an incidence rate for the primary endpoint of 1.76 versus 1.77 per 1000 person–years among 61,876 users of SGLT2 inhibitors and an equal number of DPP-4 inhibitor users, respectively, matched on their propensity to receive an SGLT2 inhibitor. And they found rates of 2.15 versus 2.96 per 1000 person–years among 55,989 SGLT2 inhibitor users and an equal number of matched GLP-1 analog users, respectively.
The findings have significant clinical implications. “Patients who may be good candidates to receive SGLT-2 inhibitors for diabetes control but who have a history of recurrent UTIs may be precluded from being prescribed these agents; because UTIs are highly prevalent in patients with diabetes, this could exclude a substantial number of patients from receiving an entire class of medications that has been shown to decrease risk for major cardiovascular events and death,” the researchers wrote. The researchers stressed that “other factors beyond risk for UTI events should be considered in decisions about whether to prescribe SGLT-2 therapy for patients with diabetes.” The study provides encouraging evidence of the real-world safety of SGLT-2 inhibitors, allowing patients to benefit from their use with greater confidence in their safety with respect to severe UTI. The study excluded individuals at high risk or with a history of UTIs, and noted that these were subgroups who required further investigation. Ann Intern Med 2019; doi:10.7326/M18-3136
Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletters:
Adam Chalela, B.S., Doctor of Pharmacy Candidate, Class of 2020, USF College of Pharmacy
Usif Darwish, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences
Kassey James, Pharm.D. Candidate, LECOM School of Pharmacy
Onyi Ibeji, PharmD. Candidate, LECOM School of Pharmacy
Amber Satz, PharmD Candidate, LECOM School of Pharmacy
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