A frightening new side effect of the latest diabetes treatments has been discovered. Patients who are taking SGLT2 inhibitors such as Farxiga or Jardiance may wake up one day to find they are running a fever while experiencing a painful rash on their genitalia or perianal area. These are among the early symptoms of a flesh-eating bacterial infection known as Fournier gangrene – a condition that requires immediate treatment.

Fournier (or Fournier’s) gangrene is the latest risk to be associated with Farxiga (dapagliflozin) and Jardiance (empagliflozin), two medications belonging to the class of medications known as Sodium Glucose Co-Transporter 2 inhibitors. These drugs operate by disabling a mechanism that causes excess blood sugar to be reabsorbed by the kidneys. Instead, it is passed out of the body through urination. When the first of these medications was introduced to the market in March of 2013, the drugmaker promoted it heavily as a medical miracle. Since then, however, all of the common SGLT2 inhibitors have been associated with dangerous and even deadly side effects, of which Fourier gangrene is only the latest to be identified.

Fournier gangrene, named for the 19th Century dermatologist Jean Alfred Fournier, was first described in medical literature in the mid-1760s. When he lectured on the disease to medical students starting in 1883, he had believed it to be a form of venereal disease. Today, medical science has determined that it is linked to alcoholism, malnutrition, a compromised immune system, and high blood sugar levels associated with diabetes.

Even then, Fournier gangrene was and is an extremely rare condition, primarily affecting older males. On the average, one patient out of 62,500 develop the disease, virtually all of whom have one or more of the above-mentioned co-morbidities. Since the introduction of SGLT2 inhibitors such as Farxiga and Jardiance, however, there has been an alarming jump in the number of cases reported.

Between 1984 and 2019, an examination of health records for diabetics taking other types of medication (such as metformin, GLP-1 receptor agonists, NIADs or glitazone drugs) revealed only 19 reported cases. However, since the introduction of SGLT2 inhibitors in 2013, there have been 55 reported cases of Fournier gangrene among patients treated with such prescription drugs. What is even more significant is that several of the victims were women. Yet, more than 97% of those who generally contract Fournier gangrene are men.

Successful treatment of Fournier gangrene is dependent upon early diagnosis. The first line of treatment consists of broad-spectrum antibiotics. If the bacteria has already started to kill off tissue, it may be necessary to remove the affected area surgically. Since the bacterium that causes Fournier gangrene is anaerobic, hyperbaric oxygen treatments may also be effective.

K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.