SGLT2 Inhibitors Are Associated with Risks for Amputation and Diabetic Ketoacidosis

In randomized trials, patients with type 2 diabetes and elevated cardiovascular disease (CVD) risk who received canagliflozin (Invokana; a sodium glucose contransporter-2 [SGLT2] inhibitor) experienced fewer adverse CV events but more lower-limb amputations than did placebo recipients (NEJM JW Gen Med Aug 1 2017 and N Engl J Med 2018; 377:644). In a new cohort study, researchers used national registers in Denmark and Sweden to examine associations between SGLT2 inhibitors and seven adverse outcomes.

More than 17,000 patients (mean age, 61) with type 2 diabetes and new prescriptions for SGLT2 inhibitors (61% dapagliflozin [Farxiga], 38% empagliflozin [Jardiance], and 1% canagliflozin) were propensity-score matched with the same number of new …