SGLT2 Inhibitors: The Star in the Treatment of Type 2 Diabetes?
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of oral hypoglycemic agents which increase urinary glucose excretion by suppressing glucose reabsorption at the proximal tubule in the kidney. SGLT2 inhibitors lower glycated hemoglobin (HbA1c) by 0.6–0.8% (6–8 mmol/mol) without inc...
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| Format: | Article |
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MDPI AG
2020-05-01
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| Online Access: | https://www.mdpi.com/2079-9721/8/2/14 |
| _version_ | 1827717108676427776 |
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| author | Yoshifumi Saisho |
| author_facet | Yoshifumi Saisho |
| author_sort | Yoshifumi Saisho |
| collection | DOAJ |
| description | Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of oral hypoglycemic agents which increase urinary glucose excretion by suppressing glucose reabsorption at the proximal tubule in the kidney. SGLT2 inhibitors lower glycated hemoglobin (HbA1c) by 0.6–0.8% (6–8 mmol/mol) without increasing the risk of hypoglycemia and induce weight loss and improve various metabolic parameters including blood pressure, lipid profile and hyperuricemia. Recent cardiovascular (CV) outcome trials have shown the improvement of CV and renal outcomes by treatment with the SGLT2 inhibitors, empagliflozin, canagliflozin, and dapagliflozin. The mechanisms by which SGLT2 inhibitors improve CV outcome appear not to be glucose-lowering or anti-atherosclerotic effects, but rather hemodynamic effects through osmotic diuresis and natriuresis. Generally, SGLT2 inhibitors are well-tolerated, but their adverse effects include genitourinary tract infection and dehydration. Euglycemic diabetic ketoacidosis is a rare but severe adverse event for which patients under SGLT2 inhibitor treatment should be carefully monitored. The possibility of an increase in risk of lower-extremity amputation and bone fracture has also been reported with canagliflozin. Clinical trials and real-world data have suggested that SGLT2 inhibitors improve CV and renal outcomes and mortality in patients with type 2 diabetes (T2DM), especially in those with prior CV events, heart failure, or chronic kidney disease. Results of recent trials including individuals without diabetes may change the positioning of this drug as ″a drug for cardiorenal protection″. This review summarizes the potential of SGLT2 inhibitors and discusses their role in the treatment of T2DM. |
| first_indexed | 2024-03-10T19:55:02Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2079-9721 |
| language | English |
| last_indexed | 2024-03-10T19:55:02Z |
| publishDate | 2020-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diseases |
| spelling | doaj.art-f7703c7430a34077a07fed584f5fb1a72023-11-20T00:06:27ZengMDPI AGDiseases2079-97212020-05-01821410.3390/diseases8020014SGLT2 Inhibitors: The Star in the Treatment of Type 2 Diabetes?Yoshifumi Saisho0Department of Internal Medicine, Keio University School of Medicine, Tokyo 1608582, JapanSodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of oral hypoglycemic agents which increase urinary glucose excretion by suppressing glucose reabsorption at the proximal tubule in the kidney. SGLT2 inhibitors lower glycated hemoglobin (HbA1c) by 0.6–0.8% (6–8 mmol/mol) without increasing the risk of hypoglycemia and induce weight loss and improve various metabolic parameters including blood pressure, lipid profile and hyperuricemia. Recent cardiovascular (CV) outcome trials have shown the improvement of CV and renal outcomes by treatment with the SGLT2 inhibitors, empagliflozin, canagliflozin, and dapagliflozin. The mechanisms by which SGLT2 inhibitors improve CV outcome appear not to be glucose-lowering or anti-atherosclerotic effects, but rather hemodynamic effects through osmotic diuresis and natriuresis. Generally, SGLT2 inhibitors are well-tolerated, but their adverse effects include genitourinary tract infection and dehydration. Euglycemic diabetic ketoacidosis is a rare but severe adverse event for which patients under SGLT2 inhibitor treatment should be carefully monitored. The possibility of an increase in risk of lower-extremity amputation and bone fracture has also been reported with canagliflozin. Clinical trials and real-world data have suggested that SGLT2 inhibitors improve CV and renal outcomes and mortality in patients with type 2 diabetes (T2DM), especially in those with prior CV events, heart failure, or chronic kidney disease. Results of recent trials including individuals without diabetes may change the positioning of this drug as ″a drug for cardiorenal protection″. This review summarizes the potential of SGLT2 inhibitors and discusses their role in the treatment of T2DM.https://www.mdpi.com/2079-9721/8/2/14sodium-glucose cotransporter 2 inhibitortype 2 diabetescardiovascular outcome trialcardiorenal protection |
| spellingShingle | Yoshifumi Saisho SGLT2 Inhibitors: The Star in the Treatment of Type 2 Diabetes? Diseases sodium-glucose cotransporter 2 inhibitor type 2 diabetes cardiovascular outcome trial cardiorenal protection |
| title | SGLT2 Inhibitors: The Star in the Treatment of Type 2 Diabetes? |
| title_full | SGLT2 Inhibitors: The Star in the Treatment of Type 2 Diabetes? |
| title_fullStr | SGLT2 Inhibitors: The Star in the Treatment of Type 2 Diabetes? |
| title_full_unstemmed | SGLT2 Inhibitors: The Star in the Treatment of Type 2 Diabetes? |
| title_short | SGLT2 Inhibitors: The Star in the Treatment of Type 2 Diabetes? |
| title_sort | sglt2 inhibitors the star in the treatment of type 2 diabetes |
| topic | sodium-glucose cotransporter 2 inhibitor type 2 diabetes cardiovascular outcome trial cardiorenal protection |
| url | https://www.mdpi.com/2079-9721/8/2/14 |
| work_keys_str_mv | AT yoshifumisaisho sglt2inhibitorsthestarinthetreatmentoftype2diabetes |