Canagliflozin – an effective and safe treatment for late type 2 diabetes

This study investigated the effectiveness and safety of canagliflozin (Invokana) as a treatment for late type 2 diabetes. 

Metformin (Glucophage) is typically the first treatment for type 2 diabetes that cannot be controlled by lifestyle alterations alone. Commonly, additional drugs are eventually required. Typically drugs like pioglitazone (Actos, G -Tase M 30, Tgmet P) are added first, followed by drugs of another type such as canagliflozin.

The main aim of treatment is to reduce blood glucose levels. This can be monitored by measuring HbA1c levels which indicate the average over the past 3 months. Unfortunately glucose-lowering treatments can produce unwanted side effects, such as hypoglycemia (low blood glucose). Other measurements of treatment effectivenss include body weight, blood pressure, levels of fats in the blood and pancreatic function (impaired in diabetes).

This study aimed to determine the effectiveness and safety of canagliflozin in late type 2 diabetics. A total of 342 patients being treated with metformin and pioglitazone were divided into 3 groups.  Two groups were treated with canagliflozin at different dosages – 100mg and 300mg for 1 year. The other treatment group received a placebo (a drug with no therapeutic effect, used as a control) for 6 months and sitagliptin (Januvia) for the remaining 6 months.

In the first 6 months, a dosage of 100mg canagliflozin reduced HbA1c levels by 0.89% and a 300mg dosage reduced levels by 1.03%, while placebo reduced levels by 0.26%. A significant reduction was also observed in body weight. Blood pressure and levels of fats in the blood were also reduced, while pancreatic function was significantly improved. These effects were sustained in the canagliflozin groups after a further 6 months.

The occurrence of any adverse event was similar in all three groups – 69.9% in canagliflozin 100mg, 76.3% in canagliflozin 300mg  and 76.5% in the placebo/sitagliptin group. These included urinary tract infections, increased volumes of urine and increased frequency of urination. Hypoglycemia was low in all 3 groups with no reports of severe hypoglycemia. 

Canagliflozin treatment was found to be both effective and safe in late type 2 diabetes patients across a diverse range of ethnicities and racial backgrounds.

The effectiveness of canagliflozin in comparison to the placebo was not measurable past the first 6 months, as placebo patients changed to sitagliptin. Further studies are required to provide evidence into the effects of canagliflozin on a longer-term basis.

Consult your doctor if you are being treated with metformin and pioglitazone and feel it would be beneficial to begin treatment with another drug such as canagliflozin.