a Single Center Retrospective Analysis of the Safety and Efficacy of SGLT2 Inhibitors in Singapore

Presentation Number: MON 615
Date of Presentation: April 3rd, 2017

Amanda Yuan Ling Lim*1, Su-Yen Goh2 and Yong Mong Bee3
1Singapore General Hospital, Singapore, SINGAPORE, 2Singapore General Hospital, Singapore, 3Singapore General Hospital, Singapore, Singapore

Abstract

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a novel class of medication to treat diabetes mellitus. SGLT2i inhibits the glucose reabsorption in the proximal renal tubules and is known to lower HbA1C, blood pressure and weight. Adverse events include genital tract infections (GTIs), urinary tract infections (UTIs) and diabetic ketoacidosis (DKA). We aim to review the safety and efficacy of SGLT2i through a retrospective review of our institution’s data, and describe the short term outcomes in our Asian patients.

Methods: We included all patients who were prescribed SGLT2i in Singapore General Hospital and National Heart Centre Singapore, from 1st April 2014 to 30th October 2015. Biomedical information including HbA1c, weight, blood pressure were collected. Adverse events resulting in Emergency Department attendances or hospital admissions including GTIs, UTIs, DKA, dehydration, renal impairment and fractures were recorded.

Results: A total of 690 patients were prescribed SGLT2i within the study period. 418 (60.6%) patients were prescribed dapagliflozin, 213 (30.9%) patients were prescribed canagliflozin and 5 (0.7%) patients were prescribed empagliflozin. 54 (7.8%) patients had a switch from one agent to another during the study period. The mean duration of diabetes was 13.5 years and the baseline HbA1C was 8.9%. The mean weight and body mass index was 80.9 kg and 29.8 kg/m2 respectively. The mean systolic blood pressure (SBP) was 136.9 mmHg and diastolic blood pressure (DBP) was 75.8mmHg. Regarding the distribution of ethnicity among the patients, 60.2% were Chinese, 20.8% were Indian, 11.2% were Malay and 7.8% were classified as other ethnicities.

Overall, in all patients initiated on SGLT2i, there was a significant reduction in mean HbA1C (0.67%, p<0.05).There was also a significant reduction in mean SBP (5.7 mmHg, p<0.05) and DBP (3.2 mmHg, p<0.05). There was reduction in mean body weight (1.3 kg, p=0.11) but was not statistically significant. Patients who were prescribed only canagliflozin and those who were prescribed only dapagliflozin were studied for differences in efficacy. There were no significant differences between both groups in terms of reduction in HbA1C, SBP or body weight.

Adverse events: There were 1 patient admitted with DKA, 1 patient with severe hypoglycaemia and acute renal impairment and 5 patients with UTIs. There were no fractures events captured.

Conclusion: The use of SGLT2i is shown to be effective in lowering HbA1C and blood pressure in our clinical practice with an Asian population. There were low rates of serious adverse events in our patients on SGLT2i.

 

Nothing to Disclose: AYLL, SYG, YMB