2 e-Letters

published between 2019 and 2022

  • Experience of SGLT2 inhibitors , Safety and side effect profile

    Dear Editor
    This indeed a very good article on emerging class of antidiabetic drugs i.e SGLT2 inhibitors. SGLT2 inhibitors are making their way not only for their role as an adjuvant therapy for control of diabetes, but their beneficial role in providing cardiac safety, renal protection and weight reduction are making these drugs superior in comparison to DPP4 inhibitors, which are another widely used and well tolerated anti diabetic drugs. SGLT2 inhibitors are known to lower blood glucose by inhibiting glucose and sodium re absorption and promoting glycosuria, as a consequence they cause glucose and HbA1C reduction and lowering of blood pressure1. A part from these benefits , SGLT2 inhibitors might acquire potential indication to be used for prevention and treatment of gout due to their uric acid reducing properties2.
    Since these drugs got FDA approval and become available, the side effect profile of these drugs have always remained talk of major debates. Well known side effects are genital infection, increase incidence of mycotic infections and diabetic ketoacidosis. One of the major and serious concern with use of SGLT2 inhibitors is possibility of Fournier’s gangrene. Fournier’s gangrene is an extremely rare but life-threatening bacterial infection of the genital tissue. Current article is also reflection of my own experience. I have been prescribing SGLT2 inhibitors quite frequently and most of the patients are in regular follow up and I have not seen any...

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  • Psychometric testing of the Norwegian Diabetes Health Profile (DHP-18) in patients with type 1 diabetes

    As author of the Diabetes Health Profile, I felt that overall the paper provided a generally balanced report of your study, I have however, a number of issues regarding your report.

    First, although resulting in a high alpha coefficient (0.79), it is incorrect to calculate an alpha score for the total number of items when the scale itself is multidimensional (Oranges and apples). In doing so, it can result in an overall low alpha score. In this case it is fortunate that the value was high. Had this been a low score this would have been perceived as a negative result to the less knowledgeable.

    Secondly, with regard to responsiveness to change, a crude method for measuring change in score was used together with a very limited patient sample. Although the limitation of the methodology was discussed to some extent in the discussion, it would have been preferable at least to measure at both pre and post for each of the three scale domains. Minimally Important Difference (MID) values are available for the DHP that would enable the smallest change in score that is clinically significant to be measured.

    Thirdly, in the section ‘Significance of the study’ it would have been more appropriate that the final comment on implementation in clinical practice and studies should have been limited to the ‘Norwegian’ version of the DHP-18. As currently phrased this is rather general and suggests the use of the DHP-18 in clinical studies per se.

    Finally, permi...

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