Blog entry by Meguid El Nahas
PROF PIERRE DELANAYE REPORTED FROM AMSETRDAM:
PROF DELANAYE REPORTING FROM EDTA IN FRENCH AND TRANSLATED BY GOOGLE:
Dr. Roussel presented safety data on a molecule studied in type 2 diabetes : the canagliflozine (CANA ) . It is an inhibitor of the co -transporter 2 sodium / glucose . The medicament increases the excretion of glucose and results in a moderate effect of osmotic diuresis . It improves diabetic control in early studies . Some patients , however, have seen their estimated GFR decline. In this study of " safety" , the authors used ( including but not limited to ) data from six randomized trials. They looked at the number of patients who had an estimated greater than 60 ml / min at the beginning ( baseline) and DFG DFG have between 45 and 60 ml / min at the end of follow-up ( 18-26 weeks). This way is already , he seems a little questionable (why by looking at the differences in GFR ?) . In randomized trials , 262 patients on 4158 (6%) were left with a GFR < 60 ml / min. In this group the effect of the molecule on glycated hemoglobin, systolic blood pressure and weight remained beneficial, as is demonstrated if the whole sample is considered . The average decrease in GFR in 6 % patients did not differ between the placebo group and the two treatment groups. The number of side effects related to volume depletion was higher in the treated group but the number of events remained very low in absolute terms . The decrease in GFR appeared to be reversible upon discontinuation of treatment ( but not shown). 60 % had no side effects.
I 'm still not totally reassured by such a study of safety . If 6% of diabetic individuals had their GFR decreased ( it is still necessary that this reduction is statistically and clinically significant, which is not known because the slopes of GFR are not considered ), I think it would be more a useful study with a measured GFR is achieved.
The jury is still out on this new class of hypoglycemic agents.
Associated risk includes:
2. UTIs, fungal in particular
3. Bladder cancer increased risk.
4. hypotension due to hypovolemia induced by osmotic diuresis
5. Decreased GFR
6. CVD benefit versus risk?
ALTOGETHER, CAUTION SHOULD BE APPLIED WHEN CONSIDERING THESE AGENTS IN T2DM PATIENTS WITH AUTONOMIC NEUROPATHY WHO ARE PRONE TO HEMODYNAMIC INSTABILITY. FURTHERMORE, I CAN FORESEE MORE AKI INDUCED BY THE OSMOTIC DIURESIS ASSOCIATED HYPOVOLEMIA AND HYPOTENSION IN THESE PATIENT SSPECIALLY THAT MOST WILL ALSO BE ON NEPHROTOXIC ACE INHIBITORS....SCAAAAARYYYYYYY!!!!