From the Guidelines
For an 88-year-old patient with glycosuria but no diabetes history who is already taking Farxiga (dapagliflozin) for CHF, no additional treatment is typically needed if blood glucose levels are normal, as the glycosuria is likely a side effect of Farxiga. However, additional testing should include a comprehensive metabolic panel, HbA1c test, and fasting plasma glucose to assess for diabetes, as recommended by recent guidelines 1. The glycosuria is likely a side effect of Farxiga, which works by blocking glucose reabsorption in the kidneys, causing glucose excretion in urine regardless of blood glucose levels. Regular monitoring of renal function, electrolytes (particularly sodium), and hydration status is important, as SGLT2 inhibitors like Farxiga can affect kidney function and fluid balance, especially in elderly patients, as noted in a recent review on polypharmacy in older people with cardiovascular disease 1. The patient should be educated about maintaining adequate hydration and recognizing signs of urinary tract infections, which can be more common with SGLT2 inhibitors. If HbA1c or fasting glucose levels indicate prediabetes or diabetes, then appropriate management would need to be initiated while considering the continued use of Farxiga for heart failure benefits, given its proven benefits in reducing the risk of worsening heart failure and cardiovascular death, as demonstrated in several large outcomes trials, including the DAPA-HF trial 1 and the EMPEROR-Reduced trial 1. Key considerations in managing this patient include avoiding excessive diuresis, monitoring for signs of hypovolemia, and being cautious with the use of other medications that may interact with Farxiga or exacerbate existing conditions, such as diuretics, which can increase the risk of hypokalemia, hyponatremia, and dehydration 1. Overall, the management of this patient should prioritize minimizing morbidity, mortality, and improving quality of life, with careful consideration of the potential benefits and risks of continued Farxiga use, as well as the need for regular monitoring and potential adjustments to the treatment plan.
From the Research
Additional Testing and Treatment for Glycosuria
The presence of glycosuria in an 88-year-old patient with no history of diabetes who is already on Farxiga (dapagliflozin) for congestive heart failure (CHF) may require further evaluation.
- The patient's glycosuria could be a result of the dapagliflozin treatment, as it is a known side effect of SGLT2 inhibitors 2.
- However, it is also important to consider other potential causes of glycosuria, such as acute tubulointerstitial nephritis (ATIN) 3.
- The patient's age and medical history should be taken into account when determining the best course of action.
- Additional testing, such as a kidney biopsy or laboratory tests to evaluate renal function, may be necessary to determine the underlying cause of the glycosuria 3.
Considerations for Dapagliflozin Treatment
- Dapagliflozin has been shown to be effective in reducing hospitalizations for heart failure in patients with and without diabetes 4.
- The drug has also been found to have antihyperglycemic, cardioprotective, and possibly renoprotective properties 5.
- However, the patient's glycosuria should be monitored and managed appropriately to minimize the risk of adverse effects.
- The patient's treatment plan should be individualized based on their specific needs and medical history.
Potential Next Steps
- Consult with a nephrologist or other specialist to determine the best course of action for managing the patient's glycosuria.
- Consider ordering additional laboratory tests or imaging studies to evaluate the patient's renal function and determine the underlying cause of the glycosuria 3.
- Monitor the patient's blood glucose levels and adjust their treatment plan as needed to minimize the risk of adverse effects 5, 4.