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In part 5 of this Exclusive Interview, John Buse talks with Diabetes in Control Publisher Steve Freed about studies on the use of SGLT in other populations — people without diabetes, people with kidney disease, etc.
John Buse, PhD, MD, is professor, chief of the Division of Endocrinology, and director of the Diabetes Center at the University of North Carolina at Chapel Hill School of Medicine.
Transcript of this video segment:
Freed: The SGLT-2s, as we found out how it affects the heart and prevents death by 40% to 50%, I would think that we would be doing clinical studies for people without diabetes for SGLT-2s, is there such a thing?
Buse: There is. So, there are trials using SGLT-2 Inhibitors, big trials, specifically with kidney disease to sort of prove in a stronger way that these drugs can prevent the progression of kidney disease. There are also trials in patients without diabetes, but who have kidney disease to look at the same endpoints. And there are trials in patients with heart failure specifically designed to address, “Does this drug change the natural history of heart failure,” and that’s being done in patients with diabetes but also being done now in patients without diabetes. Mostly because the impact in the original study was so big and the problem is intractable otherwise.
Freed: What are the chances of putting an SGLT-2 in our water supply?
Buse: Almost. There are really — other than this concern about amputation, the other side effect is genital yeast infections. So, vaginal yeast infections in women, we call it balanitis. But infection of the foreskin in men, it’s a relative minority of patients. Most will have one episode and get over it. You could almost put it in the water supply. And I would just mention that there are people who are born with mutations in SGLT-2. They functionally auto SGLT-2 inhibited themselves. It’s a relatively uncommon mutation but they tend to not have problems with obesity, they tend not to have problems with diabetes, they tend not to have problems with kidney disease. They live out a normal life expectancy with less of those problems. So, maybe we should start talking about putting it in the water supply.