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Can SGLT-2 Inhibitors Offer a Better Approach in Type 2 Diabetes?

Available studies to date looking at the benefits of using SGLT-2 inhibitors have shown positive results….

The discovery of sodium-glucose co-transporter 2 (SGLT2) inhibitors, with a novel mechanism independent of insulin secretion or sensitization, offered a new therapeutic approach for the management of type 2 diabetes mellitus. The aim of this meta-analysis was to evaluate the safety and efficacy of SGLT2 inhibitors at different doses in randomized double blind clinical trials.

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This meta-analysis was conducted by including randomized double-blind controlled trials of SGLT2 inhibitors in patients with type 2 diabetes irrespective of their antidiabetic drug exposure history but with an inadequate glycemic control. All the effect sizes were computed using the random effects model. Standardized mean differences (SMDs) and odds ratios (OR) were computed for continuous and dichotomous variables, respectively. Additional analyses like sensitivity analysis, subgroup analysis and meta-regression were also performed.

The pooled analyses demonstrated a significant reduction in mean changes in HbA1c (SMD = −0.78%, 95% CI, -0.87 to −0.69), fasting plasma glucose (FPG) (SMD = −0.70 mg/dl, 95% CI, -0.79 to −0.61), body weight (overall SMD = −0.59 kg, 95% CI, -0.65 to −0.52) and blood pressure from baseline with SGLT2 inhibitors based therapy. Consistently a significant number of patients treated with SGLT2 inhibitors achieved HbA1c < 7% (OR = 2.09, 95% CI, 1.77 to 2.46). SGLT2 inhibitors based therapy was associated with adverse events like genital and urinary tract infections.

In conclusion, in patients with type 2 diabetes, all studied doses of SGLT2 inhibitors either as monotherapy or in combination with other antidiabetic agents improved glycemic control consistently. Furthermore SGLT2 inhibitors were associated with a significant reduction in body weight and blood pressure. However, a small percentage of patients suffer from genital and urinary tract infections. Yet, SGLT2 inhibitors appear to be safe as the number of hypoglycemic events and the number of patients who discontinued therapy were similar between SGLT2 inhibitor treated groups from placebo treated patients. Finally, further investigations with long term duration of therapy are needed to establish the safety and efficacy of SGLT2 inhibitors.

Practice Pearls:
  • SGLT2 inhibitors showed a significant reduction in A1c at all doses levels
  • Furthermore SGLT2 inhibitors were associated with a significant reduction in body weight and blood pressure
  • A small percentage of patients suffer from genital and urinary tract infections

BMC Endocr Disord. 2013;13(58)