Sodium-Glucose Cotransporter-2 Inhibitors: Lack of a Complete History Delays Diagnosis.

On 15 May 2015, the U.S. Food and Drug Administration (FDA) warned that administration of sodium-glucose cotransporter-2 (SGLT2) inhibitors could lead to ketoacidosis in patients with diabetes mellitus. This announcement came more than 2 years after the FDA's first approval of an SGLT2 inhibitor, although the phenomenon had been known for more than 125 years. Luminaries of diabetes research (including Josef von Mering, Frederick Allen, I. Arthur Mirsky, and George Cahill) had described ketosis and ketoacidosis induced by administration of the phytochemical phlorizin, the prototypical SGLT inhibitor, as well as in patients with familial renal glucosuria, a condition that is considered a natural model of SGLT2 inhibition. Neither government regulators nor manufacturers of SGLT2 inhibitors evinced an awareness of this extensive historical record. The absence of historical inquiry delayed notice of ketoacidosis as an adverse reaction, which could have reduced the burden of illness from these drugs.

Assessing the efficacy of antiepileptic treatments: the ketogenic diet.

PURPOSE: To evaluate the evidence for determining if the ketogenic diet is an effective treatment for epilepsy. METHODS: A literature review of published data over the past 80 years concerning the ketogenic diet was performed, focusing on efficacy, tolerability, age of patient population, as well as study design. RESULTS: There have been several studies involving prospective and retrospective studies showing the ketogenic diet to be a very efficacious treatment in epilepsy, particularly epilepsy in childhood. However, no Class 1 studies have been published concerning the efficacy of the ketogenic diet. CONCLUSIONS: The ketogenic diet appears to be a very effective treatment for epilepsy, particularly in childhood. It would be beneficial to have Class 1 studies available to help better define the role of the diet both in children and adults.