Case of hyperosmolar hyperglycemic state by a sodium-glucose cotransporter 2 inhibitor

Abstract

The kidneys are a vital body organ in charge of adjustment and discharge of sodium and all kinds of ions. The kidneys also play an important role in maintaining glucose homeostasis through new growth and re-absorption of glucose. It is known that 90% of glucose re-absorption in the kidneys is carried out by sodium glucose cotransporter (SGLT)2. 1 A SGLT2 inhibitor was developed in order to regulate blood glucose by selectively inhibiting SGLT2 and increasing glucose discharge through the urine.The best advantage of SGLT2 is that it reduces blood glucose without being dependent on insulin and is not affected by beta cell dysfunction or insulin sensitivity. It is also has a low risk for hypoglycemia and may promote weight loss; and in combined use with insulin, weight increase resulting from insulin treatment may be decreased.Reduction in blood pressure is expected in relation to diuretic action. 2 Inhibitors of sodium-glucose cotransporters type 2 (SGLT2) are proposed as a novel approach for the management of type 2 diabetes mellitus. SGLT2 cotransporters are responsible for reabsorption of 90 % of the glucose filtered by the kidney. The glucuretic effect resulting from SGLT2 inhibition contributes to reduce hyperglycaemia and also assists weight loss and blood pressure reduction. In this study, we presented the case of a 59-year-old male who developed hyperosmolar hyperglycemic state (HHS), possibly caused by a sodium-glucose cotransporter 2 (SGLT2) inhibitor, a novel class of antihyperglycemic agents. This case highlights that HHS can develop in patients with diabetes treated with SGLT2 inhibitors