FDA has issued a warning against a newly developed and highly used class of drugs meant to treat type 2 diabetes that might cause a dangerous increase in blood acids which may lead to hospitalization.
The drugs in question are Farxiga sold by AstraZeneca (has dapaglifozin), Invokana by J&J (has canaglifozin) and Jardiance from Lilly and Boehringer (has embaglifozin). All these drugs are part of the class SGLT2 inhibitors which, in order to regulate blood sugar levels, cause sugar to be excreted into urine.
SGLT2 inhibitors drugs may produce high level of ketones. Ketones are blood acids that cannot by metabolized and excreted by the brain and which, in large quantities lead to coma and death.
When ketones accumulate in a large amount in the blood, the body enters a state named ketosis in which it starts working overtime on eliminating the toxic products. It will try to excrete as many ketones as it can through urine, this process is called ketonuria.
The ketones group consists mainly of three blood acids: acetone, acetoacetic acid and beta-hydroxybutyric acid. When these acids start building up in the blood, the blood ph drops and many enzymes, that make sure that the body is functioning properly, are inactivated. This state is common among those with end-stage type 2 diabetes and untreated type 1 diabetes.
While a person is in a ketoacidotic state (it has an increase in ketones) her breath might start smelling like acetone, which is described as a sweet and fruity smell.
From March until June, around 20 cases of people who were taking SGLT2 inhibitors were brought in hospitals with ketosis. People admitted into hospital show symptoms such as tachycardia, dehydration and hypotension. There were no reports of people arriving in severe shock at the hospital.
Type 2 diabetes is a common disease of the modern man and the many drugs found on the market to treat it, aim at lowering cholesterol, controlling blood sugar levels and lowering blood pressure levels.
Type 2 diabetes also needs to be controlled through a strict diet and exercise, as it is mostly caused by obesity.
The warning issued by FDA, might rule in favor of other type 2 diabetes drugs, such as Januvia, produced by Merck. Januvia is an alternative drug and has as an active substance a DPP4 inhibitor.
The DPP4 inhibitor class of drugs was also deemed as safe to use for patients with heart conditions in a study released recently.
Image Source: pomerenehospital