New Drugs Make Diabetics Pee Out Excess Sugar

Modest weight loss is an added benefit

man and woman toilet sign

An abnormally high level of sugar in your urine has traditionally been a sign of uncontrolled diabetes and something to be corrected. But that notion has been turned on its head by a new class of diabetes drugs that work by increasing how much sugar patients pass in their urine.

New path to blood sugar control

To date, two of these new drugs have been approved by the U.S. Food and Drug Administration for treating type 2 diabetes. The first, canagliflozin (Invokana®), was cleared last March; the second, dapagliflozin (Farxiga®), was approved just this week.

Both drugs are so-called SGLT2 inhibitors that act by blocking the kidneys’ reabsorption of sugar, or glucose. The result is that more glucose is released in the urine and the patient’s blood glucose level goes down — a major goal of diabetes treatment.

Most other available drugs for diabetes work by targeting the liver, pancreas or gut to improve insulin sensitivity, reduce insulin resistance or stimulate insulin secretion. In contrast, SGLT2 inhibitors work completely independent of insulin.

The two new medications, which are taken by mouth in pill form, are approved for use as stand-alone drug therapy, in addition to changes in diet and increased exercise, or in combination with other drugs for diabetes. Their approvals were based on multiple clinical studies — nine for canagliflozin and 16 for dapagliflozin — showing that they effectively lowered hemoglobin A1c, a measure of average blood sugar level over the previous three months.

A surprise effect on the waistline

An added benefit is that SGLT2 inhibitors are associated with modest weight loss. For instance, patients shed from 2.8 percent to 5.7 percent of body weight in clinical studies of canagliflozin.

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“The weight loss is an appealing side effect of SGLT2 inhibitors, especially in the growing population of obese individuals with type 2 diabetes,” says Cleveland Clinic endocrinologist Mary Vouyiouklis, MD. “Aside from metformin, which occasionally results in modest weight loss, other oral drugs used to treat type 2 diabetes are weight-neutral or can cause weight gain.”

Safety profile: Keeping an eye on heart effects

Another potential benefit is also a potential adverse effect: the fact that SGLT2 inhibitors have a mild diuretic effect (i.e., tend to increase urination). This results in lowering of blood pressure, which can be good for some patients who have high blood pressure but can also cause lightheadedness, dizziness or even fainting in other individuals. Dr. Vouyiouklis says caution is needed before these drugs are started in any patients at particular risk of the latter effects, such as the elderly or patients taking diuretics or multiple drugs for blood pressure.

The drugs’ other most common side effects in clinical trials — genital yeast infections and urinary tract infections — are also related to the fact that they act via the kidneys. Both drugs posed a low risk of hypoglycemia, the dangerously low blood sugar episodes associated with some diabetes therapies.

However, the new drugs were found to modestly increase levels of LDL (“bad”) cholesterol, which could be a concern because patients with diabetes are already at increased risk of heart disease. The potential for increased rates of heart attack, stroke and other cardiac events is being specifically monitored in large ongoing studies of both canagliflozin and dapagliflozin, but full results are not expected for several years.

Ongoing bladder safety scrutiny with dapagliflozin

Additionally, patients taking dapagliflozin in clinical trials showed a small increase in bladder cancer diagnoses compared with control patients. In fact, dapagliflozin was rejected for approval by the FDA two years ago because of concerns over bladder cancer and liver toxicity.

The agency’s concerns about these risks were eased by additional data from dapagliflozin’s manufacturer this time around, but the drug’s approval included a requirement that it be studied for bladder cancer risk in patients in ongoing trials as well as in new animal studies looking specifically at effects on the bladder.

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Canagliflozin does not appear to be associated with bladder cancer or liver toxicity, the FDA concluded.

More agents in the pipeline

Several other SGLT2 inhibitors may soon be available as well. One of them, empagliflozin, is in late-stage studies, and the FDA is expected to decide on its approval by the end of March.

Who should get these drugs, and when?

Dr. Vouyiouklis says obese patients with type 2 diabetes and normal kidney function stand to benefit most from SGLT2 inhibitors. In general, these drugs seem to be best tolerated by patients with normal kidney function and less well tolerated by those with moderate kidney disease (they should not be used by patients with severe kidney disease). They are not approved for use by pregnant women, patients under 18 or individuals with type 1 diabetes.

“Although SGLT2 inhibitors are approved for use as single drug therapy, metformin remains my choice for first-line oral therapy,” says Dr. Vouyiouklis. “Because SGLT2 inhibitors are relatively new and their long-term effects are not yet known, I prefer to reserve them for use as add-on therapy. I believe they will be a useful addition, especially in obese patients who are seeking to lose weight.”

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  • Carley

    I can foresee uncontrolled diabetics with type 2 getting worse with the thought of eating what they want without worry of increased insulin release and peeing out the excess sugar…Just hope the docs monitor what they eat and enforce food nutrition and not use this as a weight loss scheme!

    • delicate white.

      That is a very sizeist assumption. You are assuming that obese people are not intelligence. Discriminating against obese people doesn’t help them.

      • winston smith

        siseist??? really? what new name can fools with to much time on their hands come up with?

      • Flavius

        Oh my god “sizeist”?
        How do you get through even the simplest discussion about anything without being offended?
        And 6 people upvoted your silly tirade. Wow.

    • ashley38370048

      Ever heard for testing? The above comment is just silly. Intelligent diabetics test often and NEVER indiscriminately eat anything they want. BTW, diabetics do not worry about “increased insulin release”. Do you even know what you are talking about?

    • Christa

      Carley, have you ever been obese?? If you have not you have no clue what obese people go thru. Even if you are a dietician, if you have never been significantly overweight, you have no clue how hard you have to work against the ‘fat gene”. Yes there is such a thing as the fat gene. It is thru my entire family along with diabetes. Obese people have to work at nutrition and fighting for weight loss 4 times as much as other “normal people”

      I get so tired of the talk from persons who have never had s weight problem . So Unless you have been an obese person, save our comments for something you actually have experience on. This is not one of those things.

      • fighting DT2 hard


      • guesr

        Well said and you are totally right

      • candi pierson

        I was diagnosed with diabetes in1997. I have been overweight all of those years. I am now 64. I am type 2 and even though I doctor with an dendrochronologist, I have been uncontrolled. I am on oral meds and insulin. I have taken it upon my self to research all I can on my own and believe that doctors treat the symptoms but not the cause. Type 2 diabetes can be reversed. I know that my weight is the root of my evil and decided to do something about it before it was too late. I sought out a diabetic educator with a pH d in nutrition and joined the program. He works with the genetics and science of your body, gives you a structured eating plan and tells me I must move. I walk everyday. Some times twice. In less than 2 months I have lost 19 lbs but more importantly have reduced my insulin by 50 units per day! I look at this not as a diet but a lifestyle change. Clean eating and avoiding all processed foods and white sugar. You must be your own advocate. So, yes, I am obese and know how hard it is to lose weight but it can be done if you are committed. Genetics is just an excuse, in my opinion.

      • glarkon

        The “Fat Gene” does not exist. Laziness and overeating do, though. Stop blaming your obesity on fake health problems.

        • Sabathia

          Been overweight since I was a child. Even with a strict diet and exercise losing weight has been a slow and tiring process. Whether there is a ‘fat gene’ or not, some people have a tendency to gain weight very easily. I know this from experience and tying it to laziness and overeating is bullsh*t.

    • Thor

      Doctors can’t enforce food nutrition. They can monitor your weight, blood, etc, and send you to a nutritionist or psychologist but thats about as far as they can go. Its up to the individual to enforce what they put in their mouth at meal and snack time, not the doctor, nutritionist, or counselor.

      • guest

        Yes all true but when you gave no job and have to take handouts in order to even eat three meals a day u put what you have in your mouth so you font starve. But the downside is your sugar goes up. Drs don’t understand poor people with type two diabeties

      • candi pierson


        • Fat guy

          The humor I find in the fat question is yep I’m fat struggled with it for years. What I find humorous about that is those I share this disease with. Out of the couple dozen that come to the clinc for our monthly meetings I’m the only fat person. The rest are all skinny. Why is it that somehow the belief is only fat people are diabetics? Talk about stigma.

    • fighting DT2 hard

      What a negative point of view. Thanks for the pep talk (sarcasm intended.) I hope you are not in a health care field.

    • Serena Tagoai

      Such a harsh judgement on diabetics. Of course all diabetics just want to eat what they want without any thought of their health or consequences, or long term effects. If non diabetics had to walk in the shoes of a type 2 diabetic, they would then find out how very very difficult it is to maintain a level of blood sugar which is considered “appropriate” by the medical model, which bases it’s ‘healthy” bsl regime on very difficult and almost impossible to maintain control. You are forgetting that blood sugar is affected by a whole range of complications… i.e.. outside temperature, stress, mood, sickness, exercise (exercise actually elevates blood sugar initially), quality of sleep… so… before you judge diabetics… please be aware of ALL factors that contribute to high and your so called “uncontrolled” diabetes…. I people who don’t live with it… actually wouldn’t cope very well with this affliction for only 1 week… some of us have no other choice Carley…

      • Linda P

        You are absolutely correct. I was very thin most of my life and after a hysterectomy, I began having weight issues. No diabetes in my family…at least back three generations. No excessive thirst, but blood tests say I am diabetic. I tried to control it with diet but exercise has been an issue. They are trying me on some mess to see if that would help. I have changed my diet considerably, but have not been successful yet. It is frustrating and very difficult to maintain proper levels. The dietician I went to was a stick and obviously hyperactive and was no help at all.

  • Treatment Diaries

    Diabetics have a lot to deal with. Exchanging insight and encouraging one another goes a long way toward adherence and well being.

  • Tia Singleton

    Can this drug assist pre-diabetic patients?

    • BillC

      If you do a search for Invokana Reviews, there’s a fair number of prediabetic people who are saying they’re getting really good results when combined with diet and exercise.

    • miamirn

      Thanks for posting this!

  • david k

    The new drug has indeed helped me losing the sugar level, which was not possible with other drugs over time.

  • David Becknell

    Being a 10 year diabetic battling my weight and blood sugar, this looks promising. My new doctor recommended this for me today. I guess we will see after my blood work.

    • BillC

      Saw my diabetic nurse yesterday and she’s going to ask my doctor about putting me on it. Apparently it works quite well from what she said. 0.5 to 1.0 lower A1c plus weight loss… Count me in!

  • Sue Phillips

    My endo suggested I add the farxiga and after researching it and reading alot of user reviews I declined. So many side effects I do not want. Yeast infections are debilitating for me. Sometimes it takes me a complete month for them to go away. I can’t and won’t suffer like that. Men do not know the pain they cause. There is no way I want to take a drug that increases my bad cholesterol….dr would increase statin dose to the point I won’t be able to lift my arms or legs from muscle pain. Do I want bladder cancer as well? This drug was rejected 2 yrs ago by the FDA, now it is OK? It has not been on the market long enough to determine longterm side effects. I do not want to be the governments guinea pig.

    • candi pierson

      Good for you! Doctors are “paid” by the drug companies to push these new meds not knowing what the side effects will be down the line. You can benefit yourself by clean eating and exercise. I applaud you for researching this and refusing to put this synthetic drug in your body that may make things worse.

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  • Craig Galat

    I can see myself benefiting greatly from this.

  • ashley38370048

    I’ve been in a clinical trial for Farxiga® and couldn’t be happier with the result. My blood sugar is under much better control as I now target 70 instead of 100 as before. I’m no longer gaining weight and am actually hoping that I can someday lose enough to get rid of diabetes.

  • Jusu

    My Dad a diabetes patient but very thin, so can too take these pills.

  • Segopotso Tiro

    Are the drugs available in South Africa

  • Stefi

    Are there any contra indications for a patient with gall stones.

  • Randy Pettit

    I went from 350lbs to 209 lbs in a year this new drug works great I have dropped 18 lbs in a month on it. And my food cravings are a thing of the past. This drug is on a trial basis in Canada I am fortunate enough to be in the program so far not one of us out of the 100 on it have had any negative side affects either. We all love it.

  • Julianne

    I have been taking Farxiga since December 2014, and in the past 10 years it is the only medication that has worked. Other medications had me dropping my sugar levels too often and too low and scaring the life out of me. With this drug, which I must admit took several months to get use to because of the yeast infections and no appetite, which I had cleared up with the help of my doctor. It seems I had loss my appetite for a lot of foods which were no good for me to begin with, which was good. Now I am in better in control of my diabetes and the plus, which I really never expected, have lost 25 lbs. It might not be for everyone, but worth a try. Diabetes II runs on both sides of my family so I had to learn by trial and error and worked hand in hand with my doctor.

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  • Greg Bihndi

    OR, you could just drink more water and get more exercise.. and ignore your doctor who gets paid big bucks to prescribe this medicine

  • Brad

    Are his rates reasonable for the treatments?

  • Ghayas Khan


    Is it available for sale in the drug stores yet???