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SGLT2 Inhibitors for Type 2 Diabetes?

Researchers review potential new drug treatment options for type 2 diabetes patients….

Recently a novel class of anti-diabetic drugs known as sodium-glucose cotransporter-2 (SGLT2) inhibitors has begun to show up on the market. The first drug in this class to be approved by the FDA, Invokana™ (canagliflozin), is currently being used by many type 2 diabetics.

SGLT2 inhibitors work by inhibiting the sodium-glucose cotransporters located in the proximal tubule of the kidneys, resulting in less glucose reabsorption and more glucose being eliminated in the urine. Due to their insulin-independent mechanism, it is thought that this class of drugs may have an advantage over other classes of anti-diabetic medications, with less hypoglycemia and insulin resistance and reservation of pancreatic beta-cells.

A recent review discusses Ipragliflozin as another SGLT2 inhibitor drug currently in phase 3 clinical development for type 2 diabetes. Additionally, data from trials of multiple other SGLT2 inhibitor drugs in the development pipeline such as dapagliflozin, empagliflozin, tofogliflozin, and luseogliflozin are presented.

Favorable effects of the drug class include reductions in blood pressure, weight, blood glucose and HbA1c, less risk of hypoglycemia, possible reductions in insulin resistance and improvement in beta-cell dysfunction. Of concern is the increased risk for genitourinary tract infections due to increased glucose in the urine, which fosters bacterial growth.

The researchers concluded that SGLT2 inhibitors have been shown to be safe and efficacious, with a wide array of benefits in type 2 diabetic patients.

Practice Pearls:

  • SGLT2 inhibitors are a drug class with a novel mechanism of action that has many positive benefits in type 2 diabetics, including weight loss, reduction in blood glucose, HbA1c, blood pressure, body weight, and improvement in insulin resistance and beta-cell dysfunction.
  • SGLT2 inhibitors are associated with a concern for genitourinary tract infections due to the increase of glucose in urine.
  • Due to their insulin-independent mechanism, SGLT2 inhibitors may be combined with other anti-diabetic medications.
[Kurosaki, E., Ogasawara H. Ipragliflozin and other sodium-glucose cotransporter (SGLT2) inhibitors in the treatment of type 2 diabetes: Preclinical and clinical data. Pharmacology & Therapeutics. 2013;139:51-59.]