Abstract

DAPA DILEMMA: UNVEILING GENITO-URINARY INFECTIONS IN DAPAGLIFLOZIN THERAPY – A CASE SERIES ANALYSIS

Surya Soman*, Shikka Mary Mathew and Elizabeth James

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Abstract

Dapagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, has revolutionized the management of Type 2 Diabetes Mellitus (T2DM), especially after it was proved that the drug not only lowers HbA1c, but also reduces CV events, prevents heart failure and reduces all-cause mortality; by various multi-centric trials like DECLARE TIMI-58 trial, CVD - REAL Nordic trial. DAPA-CKD trial, etc. However, its use has been associated with a notable side effect – urinary tract infections (UTIs), mainly due to its mechanism of action producing glycosuria- which acts as a medium for micro-organisms. Other common adverse drug reactions (ADRs) include genital mycotic infections, dehydration, hypotension, and rarely, and euglycemic ketoacidosis. Many times double and triple OAD combination therapies are used because of patient refusal in initiation of insulin; also they have additional benefits over monotherapy in terms of glycemic efficacy. However, we have to be careful while using SGLT2i in combination or as monotherapy, keeping in mind the ADR. This case series emphasizes the need for heightened clinical awareness, timely recognition, and tailored interventions in mitigating the genito-urinary adverse effects of SGLT2 inhibitors, especially Dapagliflozin. This case series was collected from a tertiary health care centre in Kerala, South India. We hope our findings will contribute valuable insights to literature, informing healthcare practitioners, in evidence-based decision-making, in the evolving landscape of diabetes therapeutics.

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