Unexpected Side Effect of Weight-Loss Diabetes Drug "SGLT2 Inhibitors"

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Unexpected Side Effect of Weight-Loss Diabetes Drug “SGLT2 Inhibitors”

Unexpected Side Effect of Weight-Loss Diabetes Drug “SGLT2 Inhibitors” … Relationship with Polycythemia

Not only does it lower blood sugar, but it also helps in losing weight. However, those taking the popular SGLT2 inhibitor drug, known for its weight-loss effects in diabetes treatment, need to be cautious.There is a possibility of being diagnosed with polycythemia. Dr. Koki Shin, director of Shin Clinic in Kamata, Tokyo, specializing in diabetes, shared insights on this matter.

A 55-year-old man noticed an increase in weight after reaching retirement age from his position. Despite stepping away from a responsible role, the stress of supporting younger superiors while maintaining the department’s performance as a player was more than he had imagined.

Before he knew it, his alcohol intake had increased, and his pants were feeling tighter. He not only felt heavy but also experienced fatigue, and noticed increased thirst compared to before. He suspected he had diabetes.

“As soon as the man visited a diabetes specialist, he was diagnosed with diabetes as expected and was prescribed medication for diabetes. The medication was an SGLT2 inhibitor. He was told by the doctor, ‘If you take your medication properly, not only will your blood sugar levels decrease, but your weight will also decrease, so please take it seriously.'”

Following the doctor’s advice, the man diligently continued taking the medication, and after a while, he did indeed start losing weight. Within a month, he had lost about 4 kilograms, and his condition improved.

However, during a health check-up immediately after recovery, he was unexpectedly informed of a different condition and strongly advised to undergo further tests.

“He was told that there was a suspicion of polycythemia.”

Polycythemia is a condition where the concentration of red blood cells in the blood is elevated. This can lead to poor blood circulation, resulting in symptoms such as fatigue, weakness, headaches, dizziness, blurred vision, and congestion in the mucous membranes of the eyes and mouth. It is also common to experience facial flushing, itching of the skin, and swelling of the liver and spleen.

“As polycythemia progresses, blood clots are more likely to form, increasing the risk of conditions such as heart attacks, strokes, and pulmonary embolisms. Depending on the type of polycythemia, although rare, it can also progress to leukemia.”

Why was this man diagnosed with a suspicion of polycythemia? It was because his blood test showed high values for the components of red blood cells.

“There are two indicators that show the thickness of the blood: Hemoglobin (Hb) and Hematocrit (Ht). Hemoglobin is a type of protein in red blood cells that carries oxygen from the lungs to the rest of the body and returns carbon dioxide back to the lungs when it is no longer needed. The normal range for hemoglobin is 13.0-16.6 grams per deciliter for adult men and 11.4-14.6 grams per deciliter for adult women. Hematocrit is the percentage of red blood cells in 100 milliliters of blood, and the normal range is 40-50% for adult men and 35-45% for adult women.”

This man had abnormal values for both hemoglobin and hematocrit. The cause was the SGLT2 inhibitor drug.

Discontinuing the medication will return the values to normal, but…

“SGLT is a type of protein called a sodium-glucose co-transporter, and sodium plays a role in transporting glucose (glucose) into cells. SGLT2 is present in a specific location called the proximal tubule of the kidney. SGLT2 inhibitors suppress the reabsorption of glucose by inhibiting this function, lowering blood sugar levels.”

Unlike conventional diabetes drugs that stimulate the pancreas to secrete insulin each time the medication is taken, this drug does not strain the pancreas. Therefore, it is highly rated as a diabetes drug that is gentle on the pancreas.

However, on the other hand, it can cause the appearance of an increased proportion of red blood cells in the blood by expelling water from the blood vessels.

“There are three types of polycythemia. ① ‘Absolute polycythemia,’ where the amount of red blood cells circulating in the blood vessels increases, ② ‘Relative polycythemia,’ where the amount of plasma circulating in the blood vessels decreases, leading to an apparent increase in red blood cells, and ③ ‘Secondary erythrocytosis,’ mainly caused by smoking, where hemoglobin binds with carbon monoxide, reducing the amount of oxygen supplied to the body, resulting in an increase in red blood cells. SGLT2 inhibitors are thought to not only cause relative polycythemia but also to promote the secretion of erythropoietin, a hematopoietic factor in the kidneys, by reducing stress on the kidneys. However, at present, polycythemia caused by SGLT2 inhibitors is not a major concern, and the values return to normal once the medication is stopped.”

During health check-ups, it is important to inform the examining physician if you are taking an SGLT2 inhibitor for diabetes treatment, as there is a risk of misunderstanding. Those taking SGLT2 inhibitors should also be aware of the possibility of such occurrences.

Unexpected Side Effect of Weight-Loss Diabetes Drug "SGLT2 Inhibitors"