Not just diabetes, but medicines used to treat diabetes can put you at risk of acquiring severe infections. People with type 2 diabetes mellitus who have been prescribed a certain class of oral hypoglycemic medicines can suffer from a severe side effect- necrotising fasciitis.
The US Food and Drugs Administration has issued a warning about using a class of medicine- sodium-glucose cotransporter-2 (SGLT-2) inhibitors for long period. It has been reported that using SGLT-2 inhibitors continuously for five years can increase the chances of a rare genital infection called necrotising fasciitis. The medicines included in this category are Canagliflozin, Dapagliflozin, Empagliflozin, and Ertugliflozin. Empagliflozin reduces the risks of heart attack and stroke in people who have diabetes and heart disease.
Otherwise known as Fournier’s gangrene, the perineum can be damaged completely. The perineum is the area of skin between the anus and vulva/ scrotum. This infection is more common in males than females. The flesh-eating bacteria causing necrotising fasciitis can spread to the abdominal area as well.
How does necrotising fasciitis occur after taking SGLT-2 inhibitors?
SGLT-2 inhibitors decrease blood sugar levels by increasing the excretion of sugar from the body through urine. This helps in reducing the sugar levels in the body. As the concentration of sugar is high near the SGLT-2 receptors, the urine becomes a breeding ground for bacteria.
However, these bacteria can cause fasciitis only when there is either a cut due to shaving or if there are any pre-existing ulcers near the genital area. Since the infection is serious, one may have to undergo surgery to bring the infection under control.
Symptoms of necrotising fasciitis
One must consult a doctor if he/she experiences any of the following symptoms after taking SGLT-2 inhibitors:-
- High fever (>100.4°F)
- Swelling near the genital area
- Itching or irritation in the genital area
Treatment of necrotising fasciitis
Necrotising fasciitis can spread fast, hence prompt action should be taken to prevent the spread of fasciitis. Some of the treatment modalities that are used are:-
- Intravenous antibiotic therapy
- Surgery is done to excise the dead tissue/ skin to stop the spread of infection
- Amputation of affected limbs if required
- Hyperbaric oxygen therapy to preserve the healthy tissue
- Intravenous immunoglobulin
- Blood transfusion
Necrotising fasciitis is a dangerous and life-threatening condition. Treatment of necrotising fasciitis may require multiple surgical procedures to treat this condition. Delayed wound closure or skin grafting may be required based on the area of the skin that is affected.