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Arch Hellen Med, 37(3), May-June 2019, 320-325


SGLT-2 inhibitors and amputation: A real or an overestimated risk?

E. Xourgia, A.K. Papazafiropoulou, Α. Μelidonis
First Department of Internal Medicine and Diabetes Center, "Tzaneio" General Hospital of Pireus, Pireus, Greece

Diabetes mellitus (DM) is an established risk factor for cardiovascular morbidity and mortality. The beneficial effects of sodium-glucose cotransporter 2 (SGLT-2) inhibitors for achieving improved glycemic control, combined with the cardiovascular protection exhibited by this category of agents, have deemed them a treatment of choice for subjects with DM and notably increased cardiovascular risk. Data derived from cardiovascular studies concerning canagliflozin with pharmacovigilance analysis indicate an increased risk of amputation in the treated population, despite a canagliflozin-induced decline in major cardiovascular events. In this review we aim to assess the severity of the reported risk and investigate whether it can be considered a class-effect of SGLT-2 inhibitors, with clarification of the pathophysiological mechanisms by which such adverse events can occur.

Key words: Adverse events, Amputation, Diabetes mellitus, Sodium-glucose cotransporter 2 (SGLT-2) inhibitors.

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