From the Guidelines
SGLT inhibitors play a crucial role in diabetes management by reducing plasma glucose levels through enhanced urinary excretion of glucose 1.
Key Benefits of SGLT Inhibitors
- Glucose-lowering efficacy: SGLT inhibitors are highly effective in lowering glucose levels in patients with normal renal function 1.
- Weight and blood pressure reduction: All SGLT inhibitors are associated with a reduction in weight and blood pressure 1.
- Cardiac and renal benefits: Empagliflozin and canagliflozin have demonstrated cardiac and renal benefits in patients with established or high-risk cardiovascular disease 1.
- Reduced risk of major adverse cardiovascular events (MACE) and hospitalization for heart failure: SGLT inhibitors have been shown to reduce the risk of MACE and hospitalization for heart failure in patients with type 2 diabetes 1.
Important Considerations
- Renal function: SGLT inhibitors require intermittent monitoring of renal function and are restricted by estimated glomerular filtration rate (eGFR) 1.
- Caution with diuretics and ACE inhibitors: SGLT inhibitors should be used with caution in combination with diuretics and/or ACE inhibitors and angiotensin receptor blockers due to the risk of acute kidney injury, dehydration, and orthostatic hypotension 1.
- Increased risk of lower-limb amputation and fracture: Canagliflozin has been associated with an increased risk of lower-limb amputation and fracture, although it is uncertain whether these are class effects 1.
Clinical Use
SGLT inhibitors can be considered as an add-on therapy to metformin or as a monotherapy in patients with type 2 diabetes, particularly those with established or high-risk cardiovascular disease, heart failure, or chronic kidney disease 1.
- Dose and administration: The dose and administration of SGLT inhibitors vary depending on the specific medication and patient factors, such as renal function and concomitant medications.
- Monitoring and follow-up: Regular monitoring of blood glucose levels, renal function, and cardiovascular risk factors is essential to adjust the treatment plan accordingly.
From the Research
Role of SGLT Inhibitors in Diabetes Management
- SGLT (Sodium-Glucose Linked Transporter) inhibitors are not directly mentioned in the provided studies, however, their role is briefly discussed in relation to metformin therapy 2.
- According to the study published in Polish archives of internal medicine, newer agents such as sodium-glucose cotransporter-2 inhibitors are favored as the first-line therapy in individuals with type 2 diabetes who would benefit from cardio-renal protection 2.
- The study suggests that metformin can be used as the first-line agent in the management of diabetes, but in certain cases, SGLT inhibitors may be preferred due to their added benefits in patients with obesity, renal disease, heart failure, and cardiovascular disease 2.
Mechanism of Action and Efficacy of Metformin
- Metformin is a well-established antidiabetic medication that reduces glucose production in the liver, decreases insulin resistance, and increases insulin sensitivity 2, 3.
- The efficacy of metformin in lowering blood glucose levels has been demonstrated in several studies, with a significant reduction in HbA(1c) levels observed in patients with type 2 diabetes 3, 4, 5.
- The extended-release formulation of metformin has been shown to be effective in achieving comparable degrees of glycemic control as the immediate-release formulation, with the added benefit of once-daily dosing 4, 5.
Combination Therapy with Metformin
- Combination therapy with metformin and other antidiabetic agents, such as vildagliptin, has been shown to be effective in reducing blood glucose levels and HbA(1c) 5.
- A once-daily regimen of metformin and vildagliptin has been found to be associated with significant reductions in plasma glucose and HbA(1c), and may be a viable and cost-effective alternative to a twice-daily regimen 5.