Use of SGLT2 inhibitors tied to hypovolemia risk in patients with type 2 diabetes: Study

"It is mandatory to pay attention to hypovolemia risk associated with SGLT2 inhibitors, particularly in older people and those with moderate renal impairment," Xi Rong, Southwest Medical University, Luzhou, China, and colleagues mentioned in their study.

Type 2 diabetes mellitus is a global health problem; the condition is characterized by β-cell dysfunction, insulin resistance, and impaired glucose tolerance. There has been a dramatic increase in diabetes prevalence. Optimal glucose control is crucial for T2D treatment.

SGLT2 inhibitors are a new drug class that improves glycemia by boosting glycosuria and reducing blood pressure (BP) through osmotic diuresis and natriuresis. Although SGLT2 inhibitors are promising for T2DM treatment with cardiovascular-renal comorbidities, the potential adverse events (AEs) associated with osmotic diureses, such as hypovolemia, should not be ignored. Besides, older people, those with moderate renal impairment, and those aged ≥65 years are prone to hypovolemia-related adverse events.

Against the above background, the research team aimed to determine the hypovolemia risk for SGLT2 inhibitors treatment. For this purpose, they performed a systematic literature retrieval in online databases from inception to 4 October 2022. From each eligible study, the authors extracted data for study characteristics and outcomes of interest.

The authors reported the following findings:

• The meta-analysis included 57 studies (n = 68,622), resulting in 1,972 hypovolemia incidents (830 in the control group and 1,142 in the SGLT2 inhibitors group). The pooled RR was 1.12.
• An increased hypovolemia risk was found in patients receiving SGLT2 inhibitors.
• The result was consistent when stratified by category of SGLT2 inhibitors; upon analysis of the subgroup by age, the pooled RR was 1.14 in those aged <65 years and 1.07 in patients aged ≥65 years.
• Comparing the baseline estimated glomerular filtration rate (eGFR) of less than or equal to 60 mL/min/1.73 m2 with a baseline eGFR more significant than 60 mL/min/1.73 m2, the pooled RR was 1.21 and 1.08 respectively.

"Our meta-analysis suggested that SGLT2 inhibitors increased hypovolemia risk in T2DM patients," the researchers wrote. "Hypovolemia incidence may increase with the decreasing of eGFR and growth of age. It is critical to scrutinize the potential adverse event, except the common AEs such as genitourinary infection and hypoglycemia."

The study indicates an increase in hypovolemia linked with the treatment of SGLT2 inhibitors. It is critical to be concerned about the hypovolemia risk associated with SGLT2 inhibitors, particularly in older people and those with moderate renal impairment.

Reference:

Rong X, Zhu Y, Wen B, Liu K, Li X, Gou Q, Chen X. Risk of hypovolemia associated with sodium-glucose cotransporter-2 inhibitors treatment: A meta-analysis of randomized controlled trials. Front Cardiovasc Med. 2022 Nov 14;9:973129. doi: 10.3389/fcvm.2022.973129. PMID: 36451919; PMCID: PMC9701837.