Related Experiment Video
Updated: May 26, 2025
Comparative Proteomic Analysis of Whole Kidney, Medulla, and Cortical Tubules in Diabetic Pathogenesis of Kidney Injury in Mice
Published on: May 2, 2025
Changes in serum potassium in people with type 2 diabetes taking sodium-glucose co-transporter-2 inhibitors
Kellye Eagan1, Charlotte Bolch2, Elizabeth Van Dril3
1Riverside Medical Center, Kankakee, Illinois, USA.
Study Objective:
The primary objective of this study was to determine if there was a significant change in potassium levels with sodium-glucose co-transporter-2 (SGLT2) inhibitor therapy in people with type 2 diabetes (T2D). A co-primary objective was to evaluate which factors may predispose a patient to changes in potassium levels.
Design:
Multicenter retrospective cohort chart review.
Data Source:
Study patients were identified through an electronic medical record-generated report if they had T2D and were prescribed an SGLT2 inhibitor from January 2013 to September 2019.
Patients:
Patients were included if they had T2D, were receiving care at Advocate Medical Group, and were confirmed to have taken one of the four SGLT2 inhibitors available at the time of study approval, canagliflozin, dapagliflozin, empagliflozin, or ertugliflozin, for at least 7 days. Patients were excluded if they did not have a basic metabolic panel or comprehensive metabolic panel recorded 1 year prior to or 6 months after SGLT2 inhibitor therapy initiation.
Results:
Data extraction from the electronic medical record identified 6425 patients receiving an SGLT2 inhibitor, of which 1926 met inclusion criteria. The SGLT2 inhibitor most prescribed was canagliflozin (43.7%), followed by empagliflozin (36.9%) and dapagliflozin (19.4%). Concomitant baseline medications were thiazide diuretics (27.5%); angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or angiotensin receptor-neprilysin inhibitors (72.1%); and/or mineralocorticoid receptor antagonists (27.2%). A statistically significant change in potassium levels was found with dapagliflozin (p = 0.018); albeit not clinically significant. No other statistically significant changes or patterns were identified. The overall mean change in serum potassium from baseline was 0.021 mmol/L within 3 months; 0.007 mmol/L from 3 to 5.9 months; -0.017 mmol/L within 6-12 months; and 0.004 mmol/L after more than 12 months.
Conclusions:
No clinically significant increase or decrease in potassium levels was observed upon initiation of SGLT2 inhibitor therapy in patients with T2D. This was consistent across background medication use and patient-specific factors. Baseline potassium should not be a factor in initiating SGLT2 inhibitor therapy, if clinically indicated, in patients with T2D.
Insights
Sodium-glucose co-transporter-2 (SGLT2) inhibitor therapy in type 2 diabetes (T2D) patients did not lead to clinically significant changes in potassium levels. Baseline potassium should not deter SGLT2 inhibitor use when indicated.
Area of Science:
- Endocrinology
- Nephrology
- Pharmacology
Background:
- Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a class of medications used to manage type 2 diabetes (T2D).
- Concerns exist regarding the potential impact of SGLT2 inhibitors on serum electrolyte levels, particularly potassium.
- Understanding electrolyte changes is crucial for safe and effective diabetes management.
Purpose of the Study:
- To determine if SGLT2 inhibitor therapy causes significant changes in potassium levels in patients with T2D.
- To identify patient-specific factors that may predispose individuals to potassium level alterations during SGLT2 inhibitor treatment.
Main Methods:
- Multicenter retrospective cohort chart review of patients with T2D prescribed SGLT2 inhibitors.
- Inclusion criteria: T2D diagnosis, SGLT2 inhibitor use (canagliflozin, dapagliflozin, empagliflozin, or ertugliflozin) for at least 7 days.
- Exclusion criteria: Lack of baseline or follow-up metabolic panel data within specified timeframes.
Main Results:
- 1926 patients met inclusion criteria from an initial cohort of 6425.
- A statistically significant, but not clinically significant, change in potassium was observed with dapagliflozin (p=0.018).
- Overall mean serum potassium change from baseline was minimal across different follow-up periods (within 3 months, 3-5.9 months, 6-12 months, >12 months).
Conclusions:
- SGLT2 inhibitor initiation in T2D patients does not result in clinically significant potassium level changes.
- This finding was consistent regardless of background medication use or patient-specific factors.
- Baseline potassium levels should not be a contraindication for initiating SGLT2 inhibitor therapy when clinically indicated.
Related Concept Videos
01:28Antihypertensive Drugs: Potassium-Sparing Diuretics
01:22Diabetes Mellitus: Type 2 and Gestational
01:36Carbohydrate Metabolism
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
01:26Regulation of Sodium and Potassium
Sodium Regulation
Sodium ions make up approximately 90% of extracellular cations, with a normal blood plasma concentration of 136–148 mEq/L. A decrease in blood volume and pressure triggers the release of renin from granular cells in the juxtaglomerular complex (JGC), primarily...
01:16Antihypertensive Drugs: Action of Diuretics
01:26Oral Hypoglycemic Agents: Biguanides and Glitazones