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According to the latest safety report by the U.S. Food and Drug Administration, a popular diabetes medicine called Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors are found to raise the risk of Fournier gangrene (FG), a flesh-eating infection of the genitals, also known as necrotizing fasciitis of the genitals.
In a period of 5 years between March 2013 to Jan 2019, around 55 cases of FG has been registered in people consuming three different types of approved SGLT2 inhibitors. The names of the inhibitors linked to the cause of Fournier gangrene are as follows:
According to the survey, 3 out of 55 people hospitalized for the case of Fournier gangrene died. Among the 55 people, 16 were using dapagliflozin, 21 were taking canagliflozin, and 18 were consuming empagliflozin.
What Study Says
The study author Dr Susan Bersoff-Matcha, a medical officer in the FDA said that the occurrence of FG by taking SGLT2 inhibitors is a rare event, but in one study a link between the two were detected. According to Dr Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, the disease multiplies at a faster rate and occur mainly in the genital area and also in the anterior abdominal wall 
As per the researchers, SGLT2 inhibitors allows the kidney to flush out excess blood sugar through the urine. In the process of lowering the blood glucose, the inhibitors also lower the risk of heart-related diseases. But the side effects due to the drug caused urinary tract infection and other genital infections like fournier gangrene.
Jamie Alan, an assistant professor of pharmacology and toxicology at Michigan State University said that, the high level of sugar in any part of the body increases the risk of infection in that particular area because sugar is loved by most of the microorganisms. When the sugar-containing urine passes through the genitals, it becomes an inviting place for the bacteria. However, the infection doesn't spread right away and requires a cut or a wound to spread. After they find an entry, the microorganisms enter through the opening and start spreading. Ultimately, they rot the tissues in the area, causing Fournier Gangrene.
Another researcher who was not included in the study said that, genital infection in a diabetic is common, but FG is extremely rare 
The company that makes empagliflozin said that they constantly monitor the side effects of the medicine. However, the prescription of SGLT2 inhibitors have become low due to the risk of FG, said FDA.
-  1. Mallikarjuna, M. N., Vijayakumar, A., Patil, V. S., & Shivswamy, B. S. (2012). Fournier's Gangrene: Current Practices. ISRN surgery, 2012, 942437. doi:10.5402/2012/942437
-  2. Kordahi, A. M., & Suliman, A. S. (2017). A Case of Fournier's Gangrene. Eplasty, 17, ic25.
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