Understanding Type 2 Diabetes

What is Type 2 Diabetes?

Type 2 diabetes is a condition that impairs an individual’s ability to metabolize glucose, resulting in elevated blood-glucose levels. The primary cause of this disease is a malfunction in insulin’s function, the crucial hormone responsible for regulating glucose levels in the body. This can occur either due to insufficient insulin production or the body’s failure to effectively utilize existing insulin, known as insulin resistance.

Prevalence of Type 2 Diabetes

Type 2 diabetes affects millions globally, with approximately 90% of all diabetes patients in Canada diagnosed with this variant of the disease.

Impact on Ion Regulation

Effects on Kidney Function

Diabetes can also influence the balance of other ions regulated by the kidneys. Clinicians often prescribe canagliflozin to manage diabetes. This medication enhances the kidneys’ ability to excrete glucose, which helps restore blood glucose levels to a normal range.

Risks of Ion Imbalance

However, significant fluctuations in blood glucose levels can disrupt the balance of other crucial ions, such as calcium, phosphate, and vitamin D. Such imbalances may lead to increased uptake of these ions from bones, potentially compromising bone strength and increasing fracture risk among patients using canagliflozin.

Comparing Diabetes Medications

GLP-1 Agonists

Another class of medications prescribed for diabetes management is glucagon-like peptide-1 (GLP-1) agonists. These are believed to present a lower risk of fractures compared to canagliflozin. Nevertheless, there is limited information available that directly compares the fracture risks associated with these two types of drugs.

Recent Study Findings

To address this gap, clinician investigators from Brigham and Women’s Hospital in the United States conducted a study to compare fracture risks in patients using canagliflozin and those using GLP-1 agonists. Their findings were published in the *Annals of Internal Medicine*.

The study analyzed patient data from March 2013 to October 2015, drawing from U.S.-based commercial medical databases covering over 70 million patients. The average age of participants was 55 years.

Key Study Results

Fracture Risk Analysis

The research evaluated the incidence of fractures in various bones, including the pelvis, hip, humerus, radius, ulna, carpal, metacarpal, metatarsal, and ankle.

Conclusions

The results indicated that fracture incidences were strikingly similar between patients using canagliflozin and those on GLP-1 agonists. Consequently, the study concluded that for middle-aged patients, the fracture risk associated with canagliflozin does not significantly differ from that of GLP-1 agonist users. The investigators recommended a reassessment of the counseling provided to patients regarding the potential side effects of these medications.

Reference

Fralick, M., Kim, S. C., Schneeweiss, S., Kim, D., Redelmeier, D. A., & Patorno, E. (2019). Fracture risk after initiation of use of canagliflozin: A cohort study. *Annals of Internal Medicine*. doi:10.7326/M18-0567