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Canagliflozin should be prescribed with caution to individuals with type 2 diabetes and high risk of amputation

  • Matilde Monteiro-Soares
  • Inês Ribeiro-Vaz
  • Edward J. BoykoEmail author
Commentary

Introduction

Around 80% of lower extremity amputations (LEA) in individuals with diabetes are preceded by a diabetic foot ulcer [1]. Diabetic foot ulcers usually occur due to a direct or indirect trauma associated with loss of protective sensation and are frequently accompanied by peripheral artery disease. Several factors increase the risk of LEA in diabetic individuals with or without diabetic foot ulcers, such as male sex, sensory neuropathy, peripheral artery disease, prior history of foot ulcer or amputation, poor glycaemic control, renal dysfunction, non-Asian ethnicity and presence of infection [2, 3, 4, 5, 6, 7, 8]. Recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, in which individuals were randomised to receive intensive therapy (HbA1c <42 mmol/mol [<6%]) or standard glycaemic control (HbA1c 53–63 mmol/mol [7.0–7.9%]), showed that the intensive regimen resulted in a significant decrease in LEA risk and that mean HbA1cstrongly predicted LEA...

Keywords

Adverse drug reactions Canagliflozin Diabetic foot Lower extremity amputation SGLT2 

Abbreviations

CANVAS

CANagliflozin cardioVascular Assessment Study

CANVAS-R

CANagliflozin cardioVascular Assessment Study-Renal

DPP-4

Dipeptidyl peptidase 4

FDA

Food and Drug Administration

LEA

Lower extremity amputations

SGLT2

Sodium–glucose cotransporter 2

Notes

Contribution Statement

All authors made substantial contributions to the conception and design, drafting the article, and giving final approval of the version to be published.

Funding

VA Puget Sound Healthcare System provided support for EJB’s participation in writing this commentary. The study sponsor was not involved in the design of the study; the collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.

Duality of interest

EJB received support from Bayer AG for his participation at an expert committee meeting. MM-S and IR-V declare no duality of interest associated with this manuscript.

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Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.Center for Health Technology and Services Research (CINTESIS), Faculty of MedicineUniversity of PortoPortoPortugal
  2. 2.Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of MedicineUniversity of PortoPortoPortugal
  3. 3.Porto Pharmacovigilance Center, Faculty of MedicineUniversity of PortoPortoPortugal
  4. 4.Veterans Affairs Puget Sound Health Care System (S-123-PCC)SeattleUSA
  5. 5.University of Washington School of MedicineSeattleUSA

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