Association of initial serum sodium change and clinical outcome in patients with diabetes receiving sodium–glucose cotransporter‐2 inhibitor therapy: A multicentre database analysis in Taiwan
Authors' conclusion
While most patients with T2D maintain stable serum sodium homeostasis on SGLT2i therapy, a subset may experience dysnatraemic events with potential worse clinical consequences. Physicians should be vigilant about monitoring sodium levels and considering the associated risks when initiating SGLT2i therapy in patients with risk.
Study context
- Population
- Patients with T2D starting SGLT2i, baseline normal serum sodium (135–145 mmol/L) and follow-up sodium after 3 months of SGLT2i, multicentre health care provider in Taiwan, 1 June 2016 to 31 December 2021
- Participants
- 4,400 patients
- Exposure
- Hyponatraemia vs normal sodium vs hypernatraemia shortly after starting SGLT2i
- Hyponatraemian = 378
- Hypernatraemian = 158
- Outcome
- Serum sodium after SGLT2i initiation
- Follow-up
- Median of 2.9 (2.4, 3.4) months
Methodological detailsmulticentre database analysis
- Multicentre database analysis
Main finding
As reported in the abstract
- Overall serum sodium change (mmol/L)
- from 139.6 ± 2.4 to 139.5 ± 3.7
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| MACE · median of 26.0 monthsHyponatraemiavs Normal sodiumAdjusted for clinically relevant factors | 2.52 (1.83–3.48) | |
| Hospitalization for HF · median of 26.0 monthsHyponatraemiavs Normal sodiumAdjusted for clinically relevant factors | 1.66 (1.16–2.37) | |
| Major adverse renal events · median of 26.0 monthsHyponatraemiavs Normal sodiumAdjusted for clinically relevant factors | 2.27 (1.73–2.96) | |
| All-cause death · median of 26.0 monthsHyponatraemiavs Normal sodiumAdjusted for clinically relevant factors | 2.98 (2.17–4.11) | |
| 0.20.5125Hazard ratio (log scale) |
Non-linear analysis of initial sodium decline
- More pronounced initial decline in serum sodium correlated steeply with higher risks of these adverse events
Factors associated with dysnatraemia
- Hyponatraemia: cancer history, chronic lung disease, insulin use, higher HbA1c, impaired liver function, lower baseline sodium, greater initial decline in kidney function
- Hypernatraemia: older age, no cancer history, loop diuretic and NSAID use, higher baseline sodium, lesser initial decline in kidney function
Original publication
Association of initial serum sodium change and clinical outcome in patients with diabetes receiving sodium–glucose cotransporter‐2 inhibitor therapy: A multicentre database analysis in Taiwan. Diabetes Obes Metab. Published 21 October 2024. doi:10.
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