Muscle Atrophy-Related Adverse Events of Antidiabetic Drug Classes: A Pharmacovigilance Analysis Using VigiBase Data
Shiho Ueta1, Takahiro Niimura1,2, Mitsuhiro Goda1,3
1Department of Clinical Pharmacology and Therapeutics, University of Tokushima Graduate School of Biomedical Sciences, Tokushima, Japan.
Journal of Cachexia, Sarcopenia and Muscle
|April 14, 2026
Summary
Different antidiabetic drugs carry varying risks for muscle atrophy and related issues. Clinicians should consider these safety profiles when prescribing therapies to manage diabetes and prevent muscle function decline.
Area of Science:
- Pharmacovigilance
- Endocrinology
- Drug Safety
Background:
- Diabetes mellitus increases muscle atrophy risk.
- Some antidiabetic drugs may worsen muscle deterioration.
- Lack of comprehensive analysis on muscle atrophy adverse events across antidiabetic drug classes.
Purpose of the Study:
- Investigate muscle atrophy-related adverse events across major antidiabetic drug classes.
- Analyze safety profiles using WHO's Individual Case Safety Reports database.
Main Methods:
- Pharmacovigilance analysis of VigiBase data (1968-2025).
- Examined adverse event signals for muscle atrophy, sarcopenia, muscular weakness, and motor function decline.
- Calculated Reporting Odds Ratios (RORs) and analyzed co-occurrence patterns.
Main Results:
- Safety signals for muscle atrophy detected with sulfonylureas, GLP-1 analogues, and SGLT2 inhibitors.
- SGLT2 inhibitors showed a signal for sarcopenia; Biguanides showed signals for muscular weakness and motor function decline.
- Co-occurrence analysis revealed associations between muscle atrophy and nausea, falls, and decreased appetite.
Conclusions:
- Notable differences exist in muscle atrophy-related adverse event profiles among antidiabetic drug classes.
- Drug selection may influence muscle function decline risk; clinicians should consider safety profiles.
- Further studies are needed to establish causality and elucidate mechanisms.
Related Concept Videos
01:16Insulin: Dosing Regimen and Adverse Effects
1.3K
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
1.3K
01:19Pharmacovigilance
2.0K
Post-marketing surveillance is a critical component of pharmaceutical regulation, often uncovering unanticipated adverse drug reactions (ADRs) once a drug is widely used over an extended period.
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
2.0K
01:26Oral Hypoglycemic Agents: Biguanides and Glitazones
989
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
989
01:06Oral Hypoglycemic Agents: Glinides
995
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
995
01:15Diabetes: Management and Pharmacotherapy
1.5K
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
1.5K
01:20Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion
307
Drug metabolism, a critical process in the liver, involves two primary phases: Phase I reactions and Phase II conjugation. Obesity introduces significant alterations in this metabolic process, primarily due to fatty infiltration of the liver, leading to conditions such as nonalcoholic fatty liver disease (NAFLD). This condition can modify the activities of both Phase I and II enzymes, impacting how drugs are metabolized in obese patients.Phase I metabolism sees variable effects across...
307