Abstract
Purpose
Diabetes is a chronic metabolic disorder characterized by hyperglycemia that results
from insulin resistance, diminished or absent insulin secretion, or both. Approximately
one-half of patients with diabetes fail to achieve acceptable glycemic control. Consequently,
morbidity and mortality associated with diabetes is high, resulting from complications
such as cardiovascular disease and nephropathy. The sodium-glucose co-transporter
2 (SGLT2) inhibitors are a new class of medications for the treatment of type 2 diabetes.
This article provides an overview of efficacy and safety data for the SGLT2 inhibitors
and outlines their role in the management of diabetes.
Methods
Relevant articles were identified through searches of PubMed and International Pharmaceutical
Abstracts by using the key terms canagliflozin, dapagliflozin, empagliflozin, and sodium-glucose co-transporter 2 inhibitor. A review of bibliographies of retrieved articles was also performed to identify
additional references. All identified trials published in English and that involved
the efficacy and safety of SGLT2 inhibitors in the treatment of type 2 diabetes were
reviewed.
Findings
The SGLT2 inhibitors improve glucose control by increasing urinary glucose excretion.
Effectiveness is decreased in the presence of renal dysfunction. These agents are
efficacious as monotherapy and add-on therapy for patients with type 2 diabetes uncontrolled
on metformin, sulfonylureas, insulin, and other antihyperglycemic combinations. The
SGLT2 inhibitors lower glycosylated hemoglobin by 0.5% to 1% and fasting plasma glucose
by ~15 to 35 mg/dL, depending on the agent and the dosage used, and are also associated
with modest reductions in weight (−1.5 to −3.5 kg) and systolic blood pressure (−3
to −5 mm Hg). Genital mycotic infections and increased urination, owing to the mechanism
of action, are the most common adverse effects. In general, the class is well tolerated,
and the risk of hypoglycemia is low.
Implications
With their unique mechanism of action and good safety and tolerability profiles, the
SGLT2 inhibitors are an important addition to existing treatments for type 2 diabetes.
Because of the lack of data with this class of drugs when current treatment guidelines
for diabetes were published, the SGLT2 inhibitors are recommended as second- or third-line
therapies for diabetes. Forthcoming data on the long-term efficacy and safety profile
of these agents should help to solidify the role of SGLT2 inhibitors in the management
of diabetes.
Key words
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Article Info
Publication History
Published online: April 16, 2015
Accepted:
March 5,
2015
Identification
Copyright
© 2015 Elsevier HS Journals, Inc. Published by Elsevier Inc. All rights reserved.
