From the Guidelines
SGLT2 inhibitors are recommended as a first-line treatment for patients with type 2 diabetes who have established cardiovascular disease or kidney disease, due to their ability to reduce the risk of major adverse cardiovascular events and progression of kidney disease, as shown in the most recent study 1.
Key Points
- SGLT2 inhibitors work by preventing glucose reabsorption in the kidneys, allowing excess sugar to be excreted in urine.
- Common SGLT2 inhibitors include empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana), and ertugliflozin (Steglatro).
- The typical starting dose for empagliflozin is 10mg once daily, dapagliflozin 5mg once daily, canagliflozin 100mg once daily, and ertugliflozin 5mg once daily.
- These medications offer cardiovascular and renal benefits, reducing the risk of heart failure hospitalizations and progression of kidney disease, as demonstrated in studies such as the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) 1.
Important Considerations
- Patients should maintain adequate hydration while taking these medications and temporarily stop them during periods of illness that may cause dehydration.
- SGLT2 inhibitors should be used cautiously in patients with kidney impairment and are contraindicated in patients with type 1 diabetes due to the risk of diabetic ketoacidosis.
- Common side effects include genital yeast infections, urinary tract infections, and increased urination.
Benefits and Risks
- The benefits of SGLT2 inhibitors in reducing cardiovascular and renal risk outweigh the potential risks, as shown in studies such as the Canagliflozin Cardiovascular Assessment Study (CANVAS) 1.
- The dose of SGLT2 inhibitors should be reduced in patients with moderate renal impairment and discontinued in severe renal impairment, as recommended in guidelines such as the Standards of Medical Care for Type 2 Diabetes in China 2019 1.
From the FDA Drug Label
Sodium-glucose co-transporter 2 (SGLT2) is the predominant transporter responsible for reabsorption of glucose from the glomerular filtrate back into the circulation. Empagliflozin is an inhibitor of SGLT2
- SGLT2 Inhibitor: Empagliflozin is a medication that inhibits the SGLT2 transporter, reducing renal reabsorption of filtered glucose and increasing urinary glucose excretion.
- Mechanism of Action: By inhibiting SGLT2, empagliflozin lowers the renal threshold for glucose and increases urinary glucose excretion 2. The medication is used to improve glycemic control in adults with type 2 diabetes mellitus and to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease 2.
From the Research
SGLT2 Medications
- SGLT2 inhibitors, also known as sodium-glucose cotransporter 2 inhibitors, are a class of antidiabetic treatments used to manage type 2 diabetes mellitus 3.
- Examples of SGLT2 inhibitors include canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin 3.
- These medications are indicated for use in patients with type 2 diabetes, especially those with cardiovascular disease, high cardiovascular risk, heart failure, or renal disease 3, 4.
Benefits and Uses
- SGLT2 inhibitors have been shown to provide benefits in heart failure with reduced ejection fraction and chronic kidney disease, including in patients without diabetes 3, 4.
- They are also effective in reducing blood glucose levels, promoting weight loss, and lowering blood pressure 4, 5.
- SGLT2 inhibitors may be used as an adjunct to insulin in patients with type 1 diabetes mellitus, particularly in Europe 3.
Side Effects and Contraindications
- Common adverse events associated with SGLT2 inhibitors include mild genitourinary infections and conditions related to volume depletion 3.
- More serious adverse events, such as hypoglycemia, lower limb ischemia, and diabetic ketoacidosis, require careful attention and management 3, 4.
- SGLT2 inhibitors should be avoided in patients with a risk of diabetic ketoacidosis and used with caution in those with a history of pancreatitis or medullary thyroid cancer 4, 5.
Combination Therapy
- Combination therapy with SGLT2 inhibitors and GLP-1 receptor agonists may provide complementary benefits in managing type 2 diabetes, including improved glycemic control, weight loss, and cardiovascular risk reduction 6.
- Clinical trials have demonstrated the safety and efficacy of combination therapy with these two drug classes 6.