Invokana or Low Limp Amputation? Right to try. April 20, 2019

MELBOURNE, Australia — Canagliflozin (Invokana, Janssen) lowers the risk for progression to end-stage kidney disease by 30% in patients with type 2 diabetes and chronic kidney disease, according to first results from a global phase 3 trial that investigators called "landmark".
Diabetes Drug 'Home Run' Curtailing Kidney Failure Risk
by Maureen Salamon
https://www.medscape.com/viewarticle/911789?nlid=129429_381&src=WNL_mdplsnews_190419_mscpedit_wir&uac=164666HZ&spon=17&impID=1941804&faf=1

As we all do know, studies will shoe all what researchers were paid to confirm.  What is verdict?

The drug, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, was approved for the treatment of type 2 diabetes by the FDA and the European Medicines Agency in 2013. That indication was expanded in 2018 to include patients with established cardiovascular disease, a population in which canagliflozin can lower the risk for heart attack, stroke, and death.

Let us take a look at the comments readers posted

I am very much concerned about the  biased results of this and other similar studies using these drug. As a nephrologist  who is also diabetic,hypertensive and have borderling serum creatinine , I was very happy to read about these magic drugs, BUT after using the 3 times ( diff brands) I had all the 3 times fast and significant rise in my serum creatinine which came back to baseline after stiopping thes horroble drugs

 I did not use any of that drugs, but I used to take diuretics. The result was the same. Very severe arrhythmia. Heart rate pattern was odd. Heart skipped every seventh beat, and I even felt my heart stopped. Of cause it was not like heart stopped, but I could not take any breath. I am not med. pro. I cannot say it better. But after I stopped to take diuretics, all come back to normal. Invokana is strongest diuretic. When my endo suggested me to try it I simple said, "no".

As a practitioner, I will not see 4400 renal failure patients with diabetes in my practice lifetime. If you look at the data, it was 110 renal failure events on SGLT2 per 2200 subjects over about 2.5 years on average versus 140 renal failure events in the placebo group.  That is a difference of 1% absolute risk (1.3% really but clearly I am trying to make a point). 99% of my patients in this camp will not benefit.  Furthermore 27% of initial subjects dropped treatment during the study - 1201 people, which will truly affect results - give absolute risk reduction of 1.3%, I am certainly not calling this a HOME RUN.

What is good in the studies, they use to say how %%%% of failure and not failure. What they never said, who are those in %%% groups.  So, we take diabetic type 2 with 130 mg/dl fasting blood sugar, and put to the same group with those type 2 diabetics who has A1c12.2%. Type 2 with A1c=12.2% died, and those with 130 mg/dl crossed finish line. So, medicine is safe for every one, including those whom it killed.

A European Medicines Agency (EMA) panel has determined that a warning stating that the sodium glucose cotransporter 2 (SGLT2) inhibitors for type 2 diabetes may increase the risk for lower-limb amputation should be included in the prescribing information for all drugs in this class.

Interesting point. Why limps amputated in diabetics type 2 patients? Very interesting point I will say. The problem with limps started with high edema. Of cause, edema could be effectively treated with diuretic.  It does not. If it is effect kidney then kidney stop to discharge water.

You might not have legs but your heart and brain and kidneys will still allow you to use your wheel chair!!!

           The problem is, legs are not amputated because of wounds. Diabetics type 2 not war veterans. We got problem with blood clots because of blood does not move and clotting because of high sugar level. Also it is very poor circulation, why legs and foot are blackened.  It is diabetes type 2. Poor circulation effect all our organs, brain, kidney, heart including. Soon after one leg amputated, the wounds spread to up, to another leg, and heart stop to pump clotted blood. Remember, Invokana is strong diuretic. There is no water in blood, but a lot of sugar in it, wormed up to 36.6C and higher.
      Very interesting, it is posted by MD. Looks like MD has no one idea what it is, low-limp amputation, and pretend that diabetics type 2 with amputated limps will live happily ever after. This is why I said, do not trust in MD. They do mind own business, and this business is money. We must mind our own business, and this business is health, Well Being, and life as good as it can be.

A noble point Dr.  I did not go into the pathological reasons most likely causing increased amputations which would likely be deleterious for global microvascular insufficiency...such as 18 % less capillary exchange in the following dehydration study.  Note too the increase in Erythrocyte aggregation (Rouleaux)slowing microvascular laminar flow
https://www.ncbi.nlm.nih.gov/pubmed/12082256
'The results of our study indicated that water deprivation caused progressive reduction of blood and plasma fluidity. The increase of Ht (22%, p<0.001) and significant elevation of erythrocyte aggregation (205%, p<0.001) were observed. In spite of Ht increase, oxygen transport was decreased by 18% (p<0.05). RBC rigidity was increased under water deprivation (13.6%, p<0.05) as well as during aging. Significant correlation was found between indices of aggregation and Tk and k indices in the course of dehydration. Thus, our data indicated that dehydration caused impairment of blood and RBC rheological properties.'

         I cannot say anything better. Just use your own brain. Also when take any medicine keep closer look at if you have benefits or negative reaction. If reaction to medicine is not what you expected then stop medicine and see, if reaction vanished. Then re-start medicine to see, if side effect or negative reaction decreases your own health.  Always run your log book. Memory is tricky. Papers are reliable. Do not put too much in log book. Do not let it to be too fatty. But every medicine you take, any effect it does to you must be in this book. Every medical appointment, every comment MD said, and test you had, all in log book and special folder. This is our Medical History. Maybe it never will be used by you or someone else, but it is important to keep.
      With time probably, these log books can be studied, and bring a lot of positive impact on human life and longevity.

via Ravenvoron