Are sodium-glucose cotransporter-2 inhibitors safe for patients with diabetes and cancer?

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have heart- and kidney-related benefits for patients with and without diabetes that go beyond their initial indication for lowering blood sugar levels. In clinical trials, the risk of serious adverse events with SGLT2i has been low, but the safety outcomes of SGLT2i in patients with cancer are unknown.

A new study highlights the risk of adverse events associated with SGLT2i in patients with diabetes who also have cancer. The research findings will be presented at ASN Kidney Week 2023, November 1–5.

For the study, investigators assessed the outcomes of 3,872 patients with diabetes and cancer who were prescribed SGLT2i and 3,189 patients who were prescribed another diabetes medication called glucagon-like peptide 1 receptor agonists (GLP-1 RA).

Compared to GLP-1 RA, SGLT2i were associated with a higher risk of diabetic ketoacidosis (a buildup of acids in the blood) and fracture but lower risks of acute kidney injury and urinary tract infection. There were no differences in the incidence of hypovolemia (fluid loss), low blood pressure, and genital infection between the SGLT2i and GLP-1 RA groups.

"This is the first study to assess the safety outcomes of SGLT2i in patients with diabetes and cancer," said corresponding author Aisha Shaikh, MD, of Memorial Sloan Kettering Cancer Center. "The study findings can inform patient-physician decision-making regarding the risks of SGLT2i in these patients."