Invokana Doubles Diabetic Ketoacidosis Risk: Study

June 22, 2017 — Invokana doubles the risk of causing ketoacidosis compared to diabetes drugs in the DPP-4 inhibitor class, according to a new study published in the New England Journal of Medicine.

Study author Dr. Michael Fralick admitted that the doubled risk for ketoacidosis “sounds frightening…but the actual risk is quite small.”

He estimates that between 5 and 8 patients per 1,000 starting an SGLT2 inhibitor will develop diabetic ketoacidosis (DKA), a life-threatening condition involving too much acid in the bloodstream.

Dr. Fralick urged close monitoring because DKA can occur suddenly:

“This is something that can happen relatively quickly, so that’s why I think it’s important right after patients are started on these drugs that they’re closely monitored and the clinician considers ordering bloodwork.”

The conclusions of the study were based on data from 50,220 people with type-2 diabetes who started taking an SGLT2 inhibitor and 90,132 people with type-2 diabetes who started taking a DPP-4 inhibitor. It is the largest study to compare the risk of ketoacidosis from these drugs.

Invokana belongs to a class of diabetes drugs called SGLT2 (sodium-glucose cotransporter-2) inhibitors, which also includes Invokamet, Farxiga, Xigduo, Jardiance, and Glyxambi. They reduce blood-sugar levels by forcing the kidneys to remove more glucose in urine.

In comparison, DPP-4 (dipeptidyl peptidase-4) inhibitors work by destroying a hormone that causes the body to release glucose in the bloodstream. The names of diabetes medications in the DPP-4 inhibitor class include Januvia, Janumet, Onglyxa, Kombiglyze, Tradjenta, Glyaxmbi, Jentadueto, Nesina, Kazano, and Oseni.

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