SGLT2 Inhibitors: Assessing Risks and Red Blood Cell Changes
Type 2 diabetes treatments using SGLT2 inhibitors are often prescribed to help with cardiovascular issues. However, some patients experience erythrocytosis, which is an increase in red blood cells. This is prompting pharmacists to re-evaluate how they monitor patient safety and outcomes.
Erythrocytosis and SGLT2 Inhibitors
Medications like sodium glucose cotransporter 2 (SGLT2) inhibitors are often used for type 2 diabetes. New research indicates that erythrocytosis, an elevated red blood cell count, can affect some patients. Pharmacists are key in managing these risks, helping to identify and monitor patients.
A recent study involving more than 76,000 adults with type 2 diabetes revealed that about 6.6% of those taking SGLT2 inhibitors developed erythrocytosis within a year. This contrasted with only 2.4% in patients using other glucose-lowering drugs.
Risk Factors and Medication Variations
The study also highlighted specific risk factors. For instance, men and smokers displayed a greater likelihood of increased red blood cell counts. Men were more than four times as likely to experience erythrocytosis compared to women. Also, those using empagliflozin were more likely to develop the condition than those using dapagliflozin. Pharmacists can use this information to better monitor patients.
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Another study presented in 2024 supported that SGLT2 inhibitors boost erythropoietin levels. This suggests the red blood cell increase is a direct physiological effect, not just due to dehydration. This emphasizes the need for pharmacists to consider clinical context while interpreting lab values.
In 2022, the CDC reported that approximately 37 million Americans have diabetes, highlighting the importance of understanding the effects of associated medications (CDC 2022).
No Increased Clotting Risk Observed
Despite potential worries about blood clots due to erythrocytosis, studies have shown encouraging results. The same JAMA study found no elevated risk of venous thromboembolism, heart attack, stroke, or pulmonary embolism in patients who developed erythrocytosis while taking SGLT2 inhibitors. A broader review also did not find any evidence of harm related to clotting in this population.
Clinical Implications for Pharmacists
Pharmacists are often the first point of contact for patients’ questions and are able to spot trends in lab results. Pharmacists can monitor lab values, particularly hematocrit and hemoglobin levels in men and smokers. Also, they can provide education on side effects, review medication histories, and emphasize the importance of regular check-ups.
Conclusion
SGL2 inhibitors offer significant benefits for managing diabetes. The onset of SGLT2 inhibitors can be linked to a higher risk of erythrocytosis and an increase in hematocrit and hemoglobin levels. However, this increase was not associated with increased risk of thrombotic events. The research findings provide reassurance about the safety of SGLT2-induced erythrocytosis.