Mineral and Electrolyte Disorders With SGLT2i Therapy

Area of Science:

• Endocrinology
• Nephrology
• Pharmacology

Background:

• Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are established antidiabetic agents with demonstrated renal and cardiovascular benefits.
• Limited attention has been given to the comprehensive effects of SGLT2is on water and electrolyte balance.
• Existing data suggest potential modulations in urinary excretion of key minerals and vitamins.

Purpose of the Study:

• To review the current understanding of SGLT2i-induced electrolyte and mineral metabolism perturbations.
• To analyze the clinical implications of these metabolic changes, particularly concerning bone health.
• To identify knowledge gaps regarding the long-term impact of SGLT2is.

Main Methods:

• Review of existing clinical data and published reports on SGLT2 inhibitors.
• Analysis of studies investigating electrolyte and mineral balance in patients treated with SGLT2is.
• Examination of evidence related to bone metabolism and fracture risk associated with SGLT2i use.

Main Results:

• SGLT2is induce natriuresis and osmotic diuresis, with minor effects on serum sodium.
• Modest increases in serum potassium and magnesium, and potential increases in phosphate, FGF-23, and PTH have been observed.
• Reductions in 1,25-dihydroxyvitamin D and normal serum calcium levels are noted, with some reports suggesting a link to bone fractures.

Conclusions:

• While SGLT2is demonstrate safety and efficacy in diabetes management, their long-term effects on mineral metabolism and bone health warrant further research.
• Transient and persistent electrolyte disturbances highlight the need for careful monitoring.
• Limited long-term data and trial heterogeneity preclude definitive conclusions on fracture risk, necessitating further investigation.