From the Guidelines
Fructose and galactose are not directly affected by SGLT2 inhibitors, as these medications specifically target glucose reabsorption in the proximal tubule of the kidney. The mechanism of action of SGLT2 inhibitors is based on their ability to block the sodium-glucose cotransporter 2 (SGLT2) in the proximal tubule of the nephron, which is responsible for approximately 90% of urinary glucose reabsorption 1. This results in glucose lowering through induction of glucosuria, without directly affecting fructose or galactose transport. Fructose is primarily metabolized in the liver through fructokinase, which converts it to fructose-1-phosphate, eventually entering glycolysis. Galactose is metabolized through the Leloir pathway, being converted to glucose-1-phosphate. Understanding these distinct metabolic pathways is crucial for comprehending carbohydrate metabolism disorders like hereditary fructose intolerance and galactosemia. Some key points to consider when discussing SGLT2 inhibitors and their effects on glucose metabolism include:
- SGLT2 inhibitors have been shown to reduce cardiovascular disease and heart failure outcomes in people with diabetes, particularly those with increased cardiovascular risk or established cardiovascular disease 1.
- The use of SGLT2 inhibitors has been associated with a range of benefits, including weight loss, lowering of systolic blood pressure, and reduction of HbA1c levels 1.
- However, SGLT2 inhibitors may also be associated with an increased risk of acute kidney injury, dehydration, and orthostatic hypotension, and should be used with caution in patients with renal insufficiency or those taking diuretics and/or ACE inhibitors and angiotensin receptor blockers 1. Overall, the specificity of SGLT2 inhibitors for glucose but not other monosaccharides is a key aspect of their mechanism of action, and understanding this is essential for effective use of these medications in clinical practice.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Fructose and Galactose in Relation to SGLT2
- Fructose and galactose are simple sugars that are absorbed in the small intestine through different transport mechanisms than glucose 2.
- SGLT2 (sodium glucose cotransporter 2) is a protein that plays a key role in glucose reabsorption in the kidney, accounting for 90% of glucose reabsorption 2.
- Inhibitors of SGLT2, such as dapagliflozin, increase urinary excretion of glucose and lower plasma glucose levels in an insulin-independent manner 2.
- There is no direct evidence in the provided studies on the specific relationship between fructose, galactose, and SGLT2 inhibitors.
SGLT2 Inhibitors and Diabetes Management
- SGLT2 inhibitors are a new emerging therapeutic class in the treatment of type 2 diabetes mellitus 2.
- They have been shown to effectively control blood sugar levels without producing weight gain or hypoglycemia 2.
- SGLT2 inhibitors, such as empagliflozin, have also been associated with a reduction in major cardiovascular events and cardiovascular death 3.
- The use of SGLT2 inhibitors in combination with other antihyperglycemic agents, including insulin, is a common practice in the management of type 2 diabetes 3.
Dietary Strategies for Glycemic Control
- Various dietary strategies, such as reduced or low-carbohydrate diets, Mediterranean dietary pattern, and plant-based diets, have been shown to have beneficial effects on glycemic control 4.
- These dietary approaches may be useful in achieving weight loss and improving glycemic control in individuals with type 2 diabetes 4.
- However, there is no direct evidence on the specific effects of fructose and galactose on glycemic control in the context of SGLT2 inhibitors 4.