Invokana Linked to Increased Risk of Diabetic Ketoacidosis in New Trial

The findings of a new clinical trial suggest Invokana (canagliflozin), used for treating Type 2 diabetes may also help to treat people with Type 1 diabetes by controlling blood sugar. But, it may increase the risk of diabetic ketoacidosis (DKA) – a potentially life threatening condition that occurs when too much acid develops in the blood.

Invokana, manufactured by Janssen Pharmaceuticals (a Johnson & Johnson’s subsidiary), is only approved to treat Type 2 diabetes. However, doctors are permitted to prescribe a drug off-label – even if it’s not FDA-approved – if it might help a patient. While this can be good, it also means patients need to be fully educated as to the risks involved with use.

Researchers conducted the studies to examine the adverse events in people with Type 1 diabetes who used Invokana to control blood sugar. The study findings, by researchers at the Keck School of Medicine of the University of Southern California – reviewed data from more than 350 patients who had Type 1 diabetes for a year or more.

The findings were published in the March issue of Diabetes Care. A study with similar findings was also published in the September 2015 issue of Diabetes Care.

“People with type 1 diabetes who use an SGLT-2 inhibitor are at increased risk for DKA, which appears to be dose related,” Anne L. Peters, MD, said. “If [canagliflozin is] used in this off-label fashion, patients should be fully educated as to this risk and willing to monitor ketones at times of illness or other stress, and only the lowest dose of the SGLT-2 inhibitor should be used.”

Patient Recommendations:

• Patients should be advised of the risk and are further urged to seek medical attention if any signs or symptoms of DKA are present;
• If DKA is diagnosed or suspected, SGLT2 inhibitors should immediately be discontinued;
• Patients with a history of DKA should not be given SGLT2 inhibitors.

Patients should consult their medical doctor with any questions or concerns.