Effects of Canagliflozin, an SGLT2 Inhibitor, on the Serum and Renal Magnesium Dynamics in Patients With Type 2 Diabetes

Abstract

Recent reports have shown that a low level of serum magnesium (SMg), which is frequently observed in patients with diabetes mellitus (DM), can predict the progression of DM nephropathy and that SGLT2 inhibitor treatment increases the SMg levels. We aimed to clarify the effects of canagliflozin, an SGLT2 inhibitor, on the SMg levels, fractional urinary excretion of Mg (FEMg), estimated glomerular filtration rate (eGFR), body mass index (BMI) and HbA1c in 14 out-patients with type 2 DM. After 8.3 months of canagliflozin treatment, the SMg levels and eGFR were significantly increased compared to baseline, while the FEMg, BMI and HbA1c values were decreased. The changes in SMg (ΔSMg) and FEMg (ΔFEMg) were negatively correlated with the baseline SMg and FEMg, respectively. The ΔFEMg in patients with ΔSMg ≥0.21 mg/dL (median) was significantly greater than that in patients with ΔSMg <0.21 mg/dL. These results suggested that enhanced renal tubular Mg reabsorption may be related to an elevation of the canagliflozin-induced SMg level, partially due to an improvement in the glucose metabolism.