SGLT2 inhibitors for diabetes

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Sodium glucose cotransporter-2 inhibitors (SGLT2) are a newer, second line of medical treatment for treating blood sugar levels in people with type 2 diabetes.

SGLT2 inhibitors can help a person better control their blood sugar levels and lose weight if their current treatment is not effective.

This article describes how SGLT2 inhibitors work, who can use them, and what are the benefits.

The kidneys play an important role in maintaining stable blood sugar levels by filtering excess glucose in the bloodstream. SGLT2 inhibitors block the reabsorption of glucose from the kidneys back into the bloodstream.

Instead, Dr. Sarah Rettinger – an endocrinologist at the Providence Saint John Health Center in Santa Monica, California – expels excess glucose from the body in the urine. She said this makes SGLT2 inhibitors “very useful” in helping some people lower their blood sugar levels.

SGLT2 inhibitors are usually not the first line of treatment for people with type 2 diabetes. Dr. Rettinger often prescribes SGLT2 inhibitors to people with type 2 diabetes who are not achieving their HbA1c goals with their current medication regimen.

Recent research suggests that SGLT2 inhibitors might be useful for people with type 2 diabetes who are not interested in using insulin to lower their blood sugar.

Dr. Rettinger is also considering SGLT2 inhibitors for people with certain comorbid conditions, including:

  • Cardiovascular disease
  • Heart defect
  • Kidney disease

The Food and Drug Administration (FDA) has approved the following SGLT2 inhibitors for the treatment of type 2 diabetes:

  • Canagliflozin (Invokana)
  • Dapagliflozin (Farxiga)
  • empagliflozin (Jardiance)
  • ertugliflozin (Steglatro)

Several combination drugs are also approved by the FDA for use in people with type 2 diabetes. These include:

  • Canagliflozin / metformin (Invokamet, Invokamet XR)
  • Dapagliflozin / Metformin (Xigduo XR)
  • Dapagliflozin / saxagliptin (Qtern)
  • Empagliflozin / Linagliptin (Glyxambi)
  • Empagliflozin / metformin (synjardia, synjardia XR)
  • Ertugliflozin / metformin (Segluromet)
  • ertugliflozin / sitagliptin (Steglujan)

The different drugs vary in their dosage, as well as how and when a person should take them. People often take SGLT2 inhibitors with other diabetes drugs, such as metformin.

A person should speak to a doctor about whether any of these drugs are suitable and effective for them.

SGLT2 inhibitors can help lower blood sugar levels in people with type 2 diabetes, who do not change the number while taking other medications, explained Dr. Rettinger.

The drug may have other potential benefits as well, particularly for the heart and kidneys.

Some research suggests that SGLT2 inhibitors can help protect the heart. For people with heart failure, “some drugs in this class reduce the risk of death,” said Dr. Rettinger. This also applies to people without type 2 diabetes.

The drug may also lower the risk of deterioration in kidney function in people with chronic kidney disease, added Dr. Rettinger added.

A 2019 study review suggests SGLT2 inhibitors reduce the risk of dialysis, transplant, or death from kidney disease in people with type 2 diabetes.

A 2018 study of SGLT2 inhibitors found the following potential benefits:

  • a decrease in HbA1c levels
  • increased high density lipoprotein or “good” cholesterol levels
  • Decreased intestinal absorption of low density lipoprotein (LDL) or “bad” cholesterol along with an increase in stool LDL
  • a decrease in hypertension
  • persistent weight loss
  • a decrease in albuminuria, which is a sign of kidney disease that occurs when there is too much albumin in the urine

SGLT2 inhibitors can pose a number of risks. Dr. Rettinger found that increased urinary glucose made people more prone to urinary tract infections or yeast infections.

In 2018, the FDA warned that SGLT2 inhibitors are linked to an extremely rare but life-threatening bacterial infection of tissues in the pelvic floor called necrotizing fasciitis of the perineum (also known as Fournier’s gangrene).

A 2018 study suggests SGLT2 inhibitors may increase risk, although additional research is needed:

  • Genital and urinary tract infections
  • diabetic ketoacidosis
  • cancer
  • Broken bone
  • Foot and leg amputation

Dr. Rettinger said she doesn’t prescribe SGLT2 inhibitors to people who have in the past:

  • frequent urinary tract infections or yeast infections
  • very low bone density or frequent falls
  • Diabetic foot ulcers

She also does not recommend these drugs for people who:

  • are bedridden
  • have very low blood pressure
  • may be prone to diabetic ketoacidosis, including those who have pancreatitis or have had a history of drug or alcohol abuse

SGLT2 inhibitors are a newer drug used to lower blood sugar levels in people with type 2 diabetes. The drugs can also reduce the risk of heart and kidney disease and help some people lose weight.

However, SGLT2 inhibitors are not for everyone. Side effects can include decreased blood pressure and an increased risk of urinary tract infections or yeast infections.