Safety of sodium–glucose cotransporter 2 inhibitors in Asian type 2 diabetes populations

Abstract

The prevalence of type 2 diabetes mellitus continues to increase in many Asian countries, with possible contributing factors, such as younger‐onset disease, diabetes development at lower body mass index, higher visceral fat accumulation and poorer β‐cell function, among Asian populations. Sodium–glucose cotransporter 2 inhibitors have been shown to confer favorable effects in type 2 diabetes mellitus patients, such as improved glycemic control, weight and blood pressure reduction, and importantly, cardiorenal benefits. Sodium–glucose cotransporter 2 inhibitors are generally well‐tolerated, and have a well‐defined safety profile based on evidence from numerous clinical trials and post‐marketing pharmacovigilance reporting. To our knowledge, this review is the first to provide a comprehensive coverage of the adverse events of sodium–glucose cotransporter 2 inhibitors, as well as their management and counseling aspects for Asian type 2 diabetes mellitus populations.

Effectiveness and safety of sodium–glucose cotransporter 2 inhibitors in Asian populations

“…In recent SGLT2i trials, a reduction in the risk of composite outcome, including a decline in estimated glomerular filtration rate (eGFR), end‐stage kidney disease or death from renal causes, was also shown among Asian people 11,12 . In the Asian subanalysis of SGLT2i outcome trials, there were comparable incidences of renal‐related adverse events, such as acute kidney injury, renal impairment, eGFR decline, increased creatinine levels and renal failure, between the SGLT2i and placebo groups 13 . Using hospital medical records in Japan, the initiation of SGLT2is in the early stage of type 2 diabetes improved the eGFR slope in individuals with both rapid and moderate eGFR decline, and these renoprotective effects were more pronounced in individuals with rapid eGFR declines 14 .…”

“…Most SGLT2i outcome trials have shown a similar incidence rate or no increased risk of adverse events between the SGLT2i and control groups in Asian individuals. Furthermore, these incidence rates are relatively low in Asian people compared with those in other countries 13 . In real-world clinical practice settings, the initiation of SGLT2i therapy did not result in an increased risk of fracture in South Korea or lower-limb amputations in Japan 15,16 .…”