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Prescribers Discuss the Use of SGLT2 Inhibitors

Often, when a new class of drugs receives FDA approval, we hear from the investigators or medical professionals involved in the original studies and clinical trials and, although they may possess the most knowledge, they are often the least likely to fairly represent the opinions of most medical professionals. For this special issue we have reached out to medical professionals across the country for their thoughts and opinions to find out what they really think about SGLT-2 Inhibitors….

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Dr. Roland Lajoie, Endocrinologist, Saint Petersburg, FL — “I typically wait until a medication has some 500,000 patient uses before I will begin to prescribe drugs from a new class. Since most studies don’t enroll a large number of patients, there often is not enough use to see if the incidence of side effects is as small as the manufacturer often states.”

Gordon M. Wotton, MD, Endocrinology, Atlanta, GA — “I was excited by this new class coming to market. It makes sense. If we can eliminate the reabsorption of glucose in the kidneys, we can lower A1c and the need for insulin release from the pancreas. I have started using it in my patients as an add-on to metformin and a DPP4-I and as of yet have not seen any problems.”

Bridgette Bellingar, DO, Family Practice, Largo, FL — “I think that I would use this medication as a third line choice in my patients. Insurance coverage will definitely play a role in my use of this class. I typically start with metformin and have been adding a DPP4-I as second line. This drug might be a good choice because of the weight loss potential and seems to add nicely to the A1c-lowering effects of the other two.”

Daniel Katselnik, MD, Board Certified in Endocrinology, San Antonio, TX — “There seems to be a lot of unanswered questions on the problem with UTIs and I remember reading earlier studies where there was a higher percentage occurrence. I am very comfortable with DDP4-I and incretin-analog use and will probably want to see some post-marketing data before I commit to large scale use.”

Kelly Faulk, MD, Endocrinologist, Bismarck, ND — “I like the potential weight loss that this class of drugs may be able to deliver. If I can add this to metformin and get improved readings and maybe a couple of pounds weight loss then I think my patients will be motivated to try harder. I think that this drug will make a real difference and although I don’t have any data yet I feel that the patients I have tried it on will show improvement.”

Dr. Arpana Broor, MD, Family Practice, Rockford, IL — “I have only read about this new medication and am waiting to see what my colleagues are doing. I do have a lot of overweight patients and this seems like a good concept. I am concerned that many of my patients won’t be able to afford the co-pay and hopefully the manufacturers will make trial cards and co-pay reduction cards available.”

Dr. Angelina Sulikowski, MD, Family Practice, Buffalo, NY — “I have started 2 patients on Invokana so far and they have been using it for less than one month. Both of the patients have seen improvements in their glucose readings. One of the patients has had some urine strips and was excited to see the amount of glucose that she was peeing off. I am watching her to see if she develops a UTI and have advised her to drink extra water.”

Dr. Talal Faris, MD, Board Certified in Endocrinology, Hudson FL — “I have a large senior population and most of them are on Medicare or a Medicare supplement. I have shied away from using this medication because of the chance for UTIs and low coverage by their insurance plans. I am sure as I see more use by my colleagues and more post-marketing information comes in I will increase my use in the future.”

Dr. Mayer B. Davidson, MD, Endocrinologist, Los Angeles, CA — “I think that there’s a real niche for this class of drugs. In addition to canagliflozin’s effect on HbA1C, patients get 2 other benefits as well: weight loss and a 5-mm drop in systolic blood pressure. However I have been hesitant to use it in my overweight female patients because of a 10% to 15% genital infection rate.”

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