All About SGLT-2s
If we thought of type 2 diabetes as a puzzle, we would see that each of the pieces is just as important as the other to achieve the expected result. We know that type 2 diabetes requires what we know as self-management pillars that include seven essential parts, one of which is taking our medications.
Each person with diabetes has different requirements and fortunately, currently, there is a wide range of options for glycemic management. Today, we are going to tell you about the sodium-glucose cotransporter 2 (SGLT-2) inhibitors and how they’re used to help people with type 2 diabetes.
What are SGLT-2 Inhibitors?
These medications are also known as sodium-glucose cotransporters or gliflozins. These drugs include Invokana (canagliflozin), Farxiga (dapagliflozin) and Jardiance (empagliflozin).
This group of oral medications for the management of type 2 diabetes is relatively new as Canagliflozin was approved in 2013. They help treat diabetes by reducing renal reabsorption of glucose and increasing its urinary elimination, which decreases blood glucose concentrations.
These medications can be used as monotherapy or in combination with other medications.
How SGLT-2s Work
In short, we can say that these medications prevent our kidneys from reabsorbing glucose concentrations into our bloodstream and help the body eliminate the excess through urine.
According to the Endocrinology Network, SGLT-2s are oral drugs that lower blood glucose levels in two ways.
- By reducing the amount of glucose that is absorbed by the kidneys to excrete through urine.
- By reducing the amount of glucose in the bloodstream.
Benefits of SGLT-2s
Fasting and postprandial function: These drugs work by reducing both fasting and postprandial blood glucose levels (after meals).
Lower risk of hypoglycemia: In addition, these drugs have been reported to have a lower risk of hypoglycemia since they do not stimulate insulin production by the pancreas.
Weight loss: In some studies, it has been reported that these drugs contribute to weight loss.
Blood pressure: Another advantage of using this drug is that it can help lower blood pressure.
They are well tolerated and have few adverse intestinal effects. There is evidence to indicate that these medications have additional benefits for those at increased risk for cardiovascular disease and decreased HbA1c levels.
SGLT-2 Brand Names and Characteristics
You can find SGLT2s on the market under different names and each one has very specific characteristics, although they have a similar function. Here is a table that can help you identify each one.
Dapagliflozin (Farxiga)
- Lowers glycated hemoglobin A1c and fasting blood glucose levels
- Lowers body weight
- Lowers blood pressure by approximately 5 mmHg without increasing heart rate
- It is not associated with acute renal toxicity or impaired renal function
- Non-significant risk of hypoglycemia
Canagliflozin (Invokana)
- Significant reduction in glycated hemoglobin A1c and fasting glucose
- Slight reduction in body weight
- Lowers systolic blood pressure between 0.8 and 6.8 mmHg
- Low rate of hypoglycemia in monotherapy but higher in combination with insulin or sulfonylureas
- Presence of fungal genital infections as well as urinary tract infections of mild to moderate intensity, especially in women
Empagliflozin (Jardiance)
- Significant reduction in glycated hemoglobin A1c and fasting glucose
- Body weight reduction
- Systolic blood pressure reduction by 2 to 5 mmHg after 24 weeks
- Lower rate of hypoglycemia when used in monotherapy which increases when combined with insulin or sulfonylureas
- After 24 weeks, urinary tract infections were reported in 8 to 10% of patients and 2.3 to 2.7% of genital infections
Ipragliflozin (Sugalet)
- It is currently being developed in Japan
- Significantly lowers glycated hemoglobin A1c and fasting glucose after 12 and 24 weeks
- Induced a 1.47 kg weight decrease after 16 weeks of use
- After 12 to 16 weeks there was a decrease in systolic pressure from 3.2 to 4.3 mmHg
- Hypoglycemia was reported in 1 to 5.9%
- Urinary tract infections were rare while genital infections occurred more frequently in 3 to 4.3% of patients
What are the side effects?
Urinary tract infections have been reported among the side effects. Another reported side effect is diabetic ketoacidosis.
Conclusion
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are part of a novel treatment for diabetes management and are independent of insulin secretion and function. Studies have shown that they are effective and safe in combination with other oral medications such as metformin, sulfonylureas and thiazolidinediones, as well as with the dipeptidyl peptidase 4 (DPP-4) inhibitors or insulin.
References:
https://www.endocrinologynetwork.com/news
https://www.jacc.org/doi/full/10.1016/j.jacbts.2020.02.004
https://www.nejm.org/doi/10.1056 / NEJMoa1611925
http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0186-48662017000300363
