Doctors are being reminded about the threat of a rare genital gangrene in patients with type 2 diabetes taking SGLT-2 inhibitors, as researchers detail more post-marketing cases.

A review of adverse event reports, published in the Annals of Internal Medicine, adds to a growing body of evidence linking the drug class to Fournier gangrene, an “extremely rare but life-threatening” necrotising infection of the genitals, perineum and perianal region.

The US Food and Drug Administration (FDA) first warned about the infection after identifying 12 cases among patients taking SGLT-2 inhibitors last year. All patients required surgery and one patient died.

Shortly afterwards, Australia’s TGA announced it would investigate the safety issue.