SGLT-2 inhibitors and rare side effects in type 2 diabetes

Why have I been given this leaflet?

You have been given this leaflet because you are taking or are about to take an SGLT-2 inhibitor drug to improve the treatment of your diabetes. The name of these drugs end with ‘gliflozin’.

Examples include: 

• empagliflozin (Jardiance®) 
• canagliflozin (lnvokana®) 
• dapagliflozin (Forxiga®) 
• ertugliflozin (Steglatro®). 

These medications will lower your blood glucose levels, give increased cardiovascular protection to your heart and kidneys help you to lose weight more easily. 

Research has found that there are some rare but important side effects associated with diabetes which appear to be more common in patients taking these drugs. You should be aware of these potential side effects as if they are not identified early, they can be extremely dangerous. 

What are these side effects/symptoms?

Diabetic ketoacidosis, a condition in which there is too much acid in the blood. This can very rarely happen in some people with type 2 diabetes and these drugs can increase this risk even when the blood glucose concentration is normal.

Symptoms: Blurred vision, confusion, abdo pain or vomiting, severe thirst (sweet smelling breath) urinary frequency and fatigue.

Fournier’s gangrene.  Severe and rapid spreading skin infection in the genital or groin area which leads to abscesses and skin destruction. If treatment is delayed it can be fatal.

Symptoms: Sudden onset of pain or swelling to genitals with rapid progression, fever, malaise and foul odour.

How common are these side effects?

Diabetic ketoacidosis is estimated to occur in between 1 in 1000 and 1 in 10,000 patients treated with an SGLT-2 inhibitor. 

Fournier’s gangrene can occur in people who do not have diabetes but is more common in people with diabetes. It is estimated to occur in approximately 1 in 100,000 patients treated with an SGLT-2 inhibitor. This appears to be approximately 12 times more common than in patients treated with other diabetes drugs. Most cases of Fournier’s gangrene occur in men, but in patients treated with SGLT2 inhibitors it can also occur in women. 

If you develop any of these symptoms, contact surgery / 111 / A+E