Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

Which medication is most likely responsible for urinary frequency, urgency, and vaginal discomfort in an elderly female with Type 2 diabetes?

1. Poor glycemic management

2. Metformin side effect

3. Increased caffeine intake

4. Canagliflozin side effect

The correct answer is: Canagliflozin side effect

Canagliflozin is an SGLT2 inhibitor that is known to increase urinary glucose excretion, which can lead to osmotic diuresis. This process results in increased urine output, leading to symptoms such as urinary frequency and urgency. In elderly individuals, these symptoms can be particularly pronounced due to age-related changes in bladder function and the potential for overactive bladder conditions. Additionally, canagliflozin can also result in vaginal discomfort due to the higher concentrations of glucose in the urine, which can promote yeast infections and other urinary tract infections (UTIs), conditions that are more common in women, especially postmenopausal women. Therefore, when an elderly female with Type 2 diabetes presents with these symptoms, canagliflozin is a strong candidate as the medication responsible. In contrast, poor glycemic management may contribute to overall complications and can exacerbate urinary problems in a general sense but does not directly cause acute symptoms like urgency and frequency. Metformin, while associated with gastrointestinal side effects, is less likely to lead to urinary symptoms. Increased caffeine intake could theoretically lead to increased urinary output due to its diuretic effects, but it is not as directly linked to the specific urinary and vaginal symptoms experienced by patients using can