SGLT2i, GLP1-RA and CVOTs – sorting out the confusion

11th August 2019, Dr Chee L Khoo

All new anti-diabetic agents since 2008 have been mandated by the US FDA to conduct cardiovascular outcome trials (CVOT) to ensure that they are safe, or in statistical jargon, “non-inferior” to placebo in relation to major adverse cardiovascular events (MACE). 15 CVOTs assessing DPP‐4 inhibitors, GLP‐1 receptor agonists and SGLT‐2 inhibitors have been completed by the end of 2018 with several others to come yet.…

SGLT2 inhibitors and the diabetic kidney – friend or foe?

26th May 2019, Dr Chee L Khoo

Sometimes when a drug is contraindicated for patients with low eGFR, it may mean that usage of the drug may further damage the kidneys or increase the risk of certain adverse events. For example, the use of metformin in patients with eGFR <30 significantly increase the risk of lactic acidosis. Usage of lithium in patients with impaired renal function (low eGFR) may further damage the kidneys.…

Reduction of major CV events by SGLT2 inhibitors – who will benefit from what?

13th April 2019, Dr Chee L Khoo

SGLT2 inhibitors, as a class of anti-diabetic drugs, have been shown in multiple cardiovascular outcomes trials (EMPA-REQ, DECLARE-TIMI 58, CANVAS) to “reduce cardiovascular events in patients with type 2 diabetes (T2D)”. These are big headlines but as obsessive clinicians, we need to be more specific in the benefits of SGLT2 inhibitors in patients with T2D.…

Fournier’s gangrene & SGLT2i – how rare is it?

23rd March 2019, Dr Chee L Khoo

You may remember receiving warnings recently from the Therapeutics Goods Administration (TGA) about a serious “rare” infection, called necrotising fasciitis of the perineum, also referred to as Fournier’s gangrene (FG). FG is reported to be associated with the use of SGLT2 inhibitors in patients with type 2 diabetes (T2D). The warning came on the back of similar warnings by the US Food and Drug Authority (FDA) in August 2018.…

SGLT2 inhibitor/DPP4 inhibitor combo under PBS – sorting out the confusion

May 1, 2018 Dr Chee L Khoo

When I wrote the article last fortnight about new SLT2 inhibitor/DPP4 inhibitor combo now on the PBS, the situation was still very confused. Since that article, more information has  come to light. Yes, we are allowed to use both DPP4 inhibitors (DPP4i) and SLGT2 inhibitors (SGLT2i) together when patients with type 2 diabetes (T2D) if the HbA1c is >7.0%.…