October 1, 2015 — Invokana had higher rates of diabetic ketoacidosis than other SGLT2 inhibitors during clinical trials, but experts say the risk may be manageable and preventable, according to an editorial published in Diabetes Care.
Earlier this year, the FDA warned that 20 cases of diabetic ketoacidosis had been linked to Invokana and other diabetes drugs known as sodium-glucose co-transporter 2 (SGLT2) inhibitors. Soon afterward, European health officials said 101 cases had been reported worldwide.
Doctors Julio Rosenstock, of the Dallas Diabetes and Endocrine Center, and colleagues recommended that doctors should identify patients with risk-factors for diabetic ketoacidosis and monitor them for metabolic changes that precede the life-threatening disorder.
The researchers said patients might have a higher risk of diabetic ketoacidosis if they have another illness, reduced food or fluid intake, a history of alcohol intake, long-standing diabetes with B-cell insufficiency, latent autoimmune diabetes, and more.
They also noted that the incidence of diabetic ketoacidosis was much higher for patients on Invokana during clinical trials than other SGLT2 inhibitors, although the risk was still relatively low.
Diabetic ketoacidosis is a serious disorder that occurs when acid levels get too high in the bloodstream. Most patients have to be hospitalized. The longer diagnosis and treatment are delayed, the higher the risk of deadly complications. The problem is that many patients on SGLT2 inhibitors have only mildly elevated blood-sugar levels and very few symptoms.
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