From the Guidelines
SGLT2 inhibitors can be used in patients with pancreatogenic diabetes, but with careful consideration and close monitoring, as they offer a valuable insulin-independent mechanism of action for glucose control, as noted in the 2018 consensus report by the American Diabetes Association and the European Association for the Study of Diabetes 1. When using SGLT2 inhibitors in this population, it is essential to start with a lower dose, such as empagliflozin 10mg daily or dapagliflozin 5mg daily, and monitor closely for potential side effects, including genital infections, urinary tract infections, volume depletion, and rare but serious complications like euglycemic diabetic ketoacidosis. Key considerations for the use of SGLT2 inhibitors in patients with pancreatogenic diabetes include:
- History of pancreatitis, which may require cautious use or alternative treatments, as suggested by the 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease 1
- Renal function, as SGLT2 inhibitors are contraindicated in severe renal impairment (eGFR <30 ml/min/1.73m²) and their efficacy decreases with declining renal function, as noted in the European Medicines Agency and U.S. Food and Drug Administration prescribing information 1
- Cardiovascular and renal protective benefits, which may be valuable in this patient population, as demonstrated by studies such as the EMPA-REG OUTCOME trial and the CANVAS program 1 Regular kidney function assessment is crucial, and caution should be taken when conditions are present that may reduce eGFR, such as combination therapy with diuretics and/or ACE inhibitors and angiotensin receptor blockers, as highlighted in the 2018 consensus report by the American Diabetes Association and the European Association for the Study of Diabetes 1. By carefully weighing the benefits and risks, SGLT2 inhibitors can be a valuable addition to the treatment regimen for patients with pancreatogenic diabetes, as supported by the highest quality and most recent evidence available 1.
From the Research
SGLT2 Inhibitors in Pancreatogenic Diabetes
- The provided studies do not directly address the use of SGLT2 inhibitors in patients with pancreatogenic diabetes, but rather focus on their use in type 2 diabetes mellitus (T2DM) 2, 3, 4, 5, 6.
- However, it is worth noting that SGLT2 inhibitors have been shown to be effective in improving glycemic control, reducing body weight and blood pressure, and having a low risk of hypoglycemia in patients with T2DM 2, 4, 5, 6.
- A systematic review and meta-analysis found that SGLT2 inhibitors were not associated with an increased risk of acute pancreatitis or pancreatic cancer in patients with T2DM, although the quality of evidence for pancreatic cancer was very low 3.
Pancreatic Safety of SGLT2 Inhibitors
- The pancreatic safety of SGLT2 inhibitors has been evaluated in several studies, with most finding no significant increase in the risk of pancreatitis or pancreatic cancer 3.
- However, the overall safety of SGLT2 inhibitors, including their effects on the pancreas, is still being studied and more research is needed to fully understand their potential risks and benefits 2, 3.
Use of SGLT2 Inhibitors in Clinical Practice
- SGLT2 inhibitors, such as canagliflozin, have been approved for the treatment of T2DM and can be used as monotherapy or in combination with other antihyperglycemic agents 4, 5, 6.
- They offer a novel insulin-independent mechanism of action and have been shown to be effective in improving glycemic control and reducing body weight and blood pressure in patients with T2DM 2, 4, 5, 6.