New safety warnings were issued by the FDA for dipeptidyl peptidase–4 (DPP-4) inhibitors, and sodium–glucose linked transporter–2 (SGLT-2) which are two oral agents for blood glucose control in type 2 diabetes. Warning of heart failure risk associated with one of the DPP-4 inhibitors, saxagliptin, were voted to be included on the drug label based on a large study (SAVOR). The study had nearly 16,500 people with type 2 diabetes and risk factors for cardiovascular events; more hospitalization due to heart failure occurred in the saxagliptin group (3.5%) than in the placebo group (2.8%) over 2 years of follow up. However, two other large randomized controlled trials (EXAMINE and TECOS) did not confirm this risk. The safety warning for SGLT-2 inhibitors was published after reports of diabetic ketoacidosis (DKA), a dangerous accumulation of acid in the blood, which required emergency visit or hospitalization in people with type 1 and type 2 diabetes. Yet, the reports did not prove a cause and effect link between the medications and DKA. When dispensing DPP-4 inhibitors and SGLT-2 inhibitors, it is recommended for pharmacists to assess patients’ specific risk factors and weigh them against benefits, providing appropriate patient counseling. How many of your patients are prescribed these two classes of drugs?
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