{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:46:50Z","timestamp":1793123210365,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:00:00Z","timestamp":1729468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:00:00Z","timestamp":1729468800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The study aimed to assess the impact of varying degrees of initial serum sodium change among patients with type 2 diabetes (T2D) starting sodium\u2013glucose cotransporter\u20102 inhibitor (SGLT2i) therapy and their subsequent clinical outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used medical data from a multicentre health care provider in Taiwan and recruited 4400 patients with T2D with baseline normal serum sodium (135\u2013145\u2009mmol\/L) and follow\u2010up serum sodium measures available after 3\u2009months of SGLT2i treatment from 1 June 2016 to 31 December 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After a median of 2.9 (2.4, 3.4) months of SGLT2i treatment, overall, there was a minimal change in serum sodium levels (from 139.6\u2009\u00b1\u20092.4 to 139.5\u2009\u00b1\u20093.7\u2009mmol\/L). Most patients (87.8%) maintained normal sodium levels, while 8.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009378) experienced hyponatraemia (&lt;135\u2009mmol\/L) and 3.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009158) hypernatraemia (&gt;145\u2009mmol\/L). Factors independently associated with hyponatraemia included cancer history, chronic lung disease, insulin use, higher glycated haemoglobin, impaired liver function, lower baseline sodium and greater initial decline in kidney function. Conversely, factors linked to hypernatraemia included older age, absence of cancer history, loop diuretic and non\u2010steroidal anti\u2010inflammatory drug use, higher baseline sodium and a lesser initial decline in kidney function. Over a median of 26.0\u2009months of follow\u2010up, hyponatraemia shortly after starting SGLT2i therapy was associated with significantly increased risks of major adverse cardiovascular events [hazard ratio (HR): 2.52; 95% confidence interval (CI): 1.83\u20133.48], heart failure for hospitalization (HR: 1.66; 95% CI: 1.16\u20132.37), major adverse renal events (HR: 2.27; 95% CI: 1.73\u20132.96) and all\u2010cause death (HR: 2.98; 95% CI: 2.17\u20134.11) after adjusting for clinically relevant factors. Non\u2010linear analysis indicated that a more pronounced initial decline in serum sodium levels correlated steeply with higher risks of these adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While most patients with T2D maintain stable serum sodium homeostasis on SGLT2i therapy, a subset may experience dysnatraemic events with potential worse clinical consequences. Physicians should be vigilant about monitoring sodium levels and considering the associated risks when initiating SGLT2i therapy in patients with risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.16011","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T06:00:37Z","timestamp":1729490437000},"page":"247-258","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of initial serum sodium change and clinical outcome in patients with diabetes receiving sodium\u2013glucose cotransporter\u20102 inhibitor therapy: A multicentre database analysis in Taiwan"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7816-6305","authenticated-orcid":false,"given":"Yu\u2010Wen","family":"Cheng","sequence":"first","affiliation":[{"name":"The Cardiovascular Department Chang Gung Memorial Hospital  Linkou Taiwan"},{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1406-8503","authenticated-orcid":false,"given":"Yi\u2010Hsin","family":"Chan","sequence":"additional","affiliation":[{"name":"The Cardiovascular Department Chang Gung Memorial Hospital  Linkou Taiwan"},{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"School of Traditional Chinese Medicine, College of Medicine Chang\u2010Gung University  Taoyuan City Taiwan"},{"name":"Microscopy Core Laboratory Chang Gung Memorial Hospital  Linkou Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi","family":"Chuang","sequence":"additional","affiliation":[{"name":"The Cardiovascular Department Chang Gung Memorial Hospital  Linkou Taiwan"},{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Division of Cardiology, Department of Medicine New Taipei City Municipal Tucheng Hospital (Chang Gung Memorial Hospital)  New Taipei City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao\u2010Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center Chang Gung University  Taoyuan City Taiwan"},{"name":"Center for Big Data Analytics and Statistics Chang Gung Memorial Hospital  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tze\u2010Fan","family":"Chao","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Taipei Veterans General Hospital  Taipei City Taiwan"},{"name":"Institute of Clinical Medicine, Cardiovascular Research Center National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Wei","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Applied 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