Marked Weight Loss, Muscle Wasting and Fatigue on Administration of Empagliflozin in a Subject with Type 2 Diabetes

Background: Weight loss, fatigue and decreased quality of life are frequently reported at the time of initial diagnosis by subjects with Diabetes Mellitus of both types although far more frequently with type 1 and are attributed to fluid and electrolyte losses due to persistent glycosuria as well as decline in adipose tissue secondary to lipolysis. However, muscle wasting and weakness as initial manifestations are noted almost exclusively in subjects with type 1 diabetes.
Case Report: A man with history of type 2 diabetes about 10 years reported onset of general fatigue, polyuria, nocturia, polydipsia as well as profound progressive weight loss, muscle wasting and weakness within 2 weeks after initiation of Empagliflozin. He had been receiving glimepiride 8 mg and metformin 2000 mg daily for about 5.5 years. Resolution of polyuria, nocturia and polydipsia was attained promptly within a week after discontinuation of Empagliflozin and initiation of insulin glargine. Weight gain and improvement in fatigue began by 2 weeks, continued until achieving desirable glycemic control over next 4 months and then stabilized. However, muscle mass and strength have not yet returned to the level prior to initiation of Empagliflozin during the follow up period of 12 months.
Conclusion: Empagliflozin is responsible for induction of transient weight loss as well as persistent muscle weakness and wasting in this subject.