Fda warns that sglt2 inhibitors for diabetes may result in a. Recently, several sglt2 inhibitors that block glucose reabsorption in the proximal tubule via the sodiumdependent glucose transporter have been approved for the treatment of type 2 diabetes. The faculty will address these issues and provide practice pearls for pharmacists. Sglt2 inhibitors are only approved for the management of type 2 diabetes mellitus t2dm.
Phlorizin isolated from the bark of apple trees is the first natural substance with sglt inhibitory activity. Sglt2 inhibitor is an abbreviation for sodiumglucose cotransporter2 inhibitors. Is an sglt2 inhibitor right for your patient with type 2. Written by experts in the field, this clinical handbook explores the novel sglt2 drug class for the treatment of diabetes. The glucoselowering mechanism of sglt2 inhibitors has been detailed in a proof of principle study in patients with well controlled t2d and normal renal function.
Note that the order in the chart is determined by historical introduction and route of administration and is not meant to imply any specific preference. Notably, the glucoselowering efficacy of sglt2 inhibitors is directly related to the. List of sglt2 inhibitors sodiumglucose cotransporter2. Sglt2 inhibitors are a class of medicine used to lower high blood glucose levels in people with type 2 diabetes. To download this set of slides in powerpoint format. An overview article pdf available in current drug safety 2 february 2018 with 1,784 reads how we measure reads. Sglt2 inhibition in the diabetic kidneyfrom mechanisms to. The potency and positioning of sglt2 inhibitors as an antidiabetic drug are dependent on their characteristic profile, which. The sodiumglucose cotransporter 2 sglt2 inhibitors are a class of glucoselowering therapies that have been shown to reduce risks of heart failure hf events in patients with type 2 diabetes mellitus t2dm at highrisk for or with cardiovascular disease. In assessing the cardiovascular cv safety profiles of antidiabetic drugs. To date, various sglt2 inhibitors have been developed and evaluated in clinical studies. Effects of sodium glucose contransporter sglt2 inhibition on renal.
Essentials of sglt2 inhibitors in diabetes pdf download. The role of sglt2 inhibitors in glucose reabsporption. Pdf sglt2 inhibitors may predispose to ketoacidosis. The typical dose is 100 300 mg canagliflozin, 510 mg dapagliflozin, or 10 25 mg empagliflozin, depending on the patients needs. Fda warns that sglt2 inhibitors for diabetes may result in a serious condition of too much acid in the blood. It is to be used in conjunction with diet and exercise. Methods and analysis bmj open bmj open is a medical.
Essentials of sglt2 inhibitors in diabetes pdf author miles fisher isbn 331943294x file size 1. Practice pearls for sglt2 inhibitors activity overview this activity will focus on current issues related to the use of sglt2 inhibitors in patients with diabetes. Sglt2 inhibitors are used in the treatment of type ii diabetes mellitus t2dm. Sodiumglucose cotransporter 2 sglt2 inhibitors reduce hospitalization for heart failure hf in patients treatment of diabetic kidney disease view in chinese doses of other sglt2 inhibitors eg, 10 mg once daily of empagliflozin or 5 mg once daily of dapagliflozin are reasonable as treatment of dkd in patients with type 2 diabetes. Effect of sglt2 inhibitors on cardiovascular, renal and. Data is lacking to support use for the treatment of t1dm at this time table 2. Sglt2 inhibitors, also called gliflozins, are a class of medications that inhibit reabsorption of glucose in the kidney and therefore lower blood sugar. Burke department of pharmacy practice, chicago college of pharmacy, midwestern university, chicago, illinois. Sodium glucose cotransporter type 2 sglt2 inhibitors. Sep 17, 2017 the differential equations describing the system sglt2sglt2i will make even the hard core urea kineticists run for cover not shown to protect the innocent 47. The actions of sglt2 inhibitors on metabolism, renal function and blood pressure. Sglt2i empaglifozin canagliflozin dapagliflozin ertugliflozin comparator placebo placebo placebo placebo patients enrolled cvd cv risk. A mild state of ketosis also contributes to reduction of sympathetic tone.
Staying on top of such a huge evidence base is challenging. Renoprotective effects of combined sglt2 and ace inhibitor. Cvd and t2dm share common risk factors for development and progression, and there is significant overlap between the conditions in terms of worsening outcomes. Random effects models were used to estimate pooled relative risks. Sodiumglucose cotransporter2 sglt2 inhibitors are a newly developed class of oral antidiabetic drugs oads with a unique mechanism of action. Apr 21, 2016 sodium glucose co transporter sglt2 inhibitors 1. Sglt2 i empaglifozin canagliflozin dapagliflozin ertugliflozin comparator placebo placebo placebo placebo patients enrolled cvd cv risk. Rieg and vallon begin the series by tracing the development of the sglt inhibitor class of drugs, including sglt1 inhibitors, sglt2 inhibitors. Seven days of dapagliflozin treatment reduced the calculated renal threshold for plasma glucose from 196 to 22 mgdl 10. Nov 26, 2014 sodiumglucose cotransporter2 sglt2 inhibitors are a newly developed class of oral antidiabetic drugs oads with a unique mechanism of action. View and download powerpoint presentations on sglt2 inhibitors ppt. Elevated ketone bodies with sglt2 inhibitors and in hf.
Large mortalitymorbidity trials in type 2 diabetes excluding ckd and hf trials empareg. Consequently, sglt2 inhibitors reduce plasma glucose insulin independently and improve insulin resistance in diabetes. By inhibiting sglt2, these drugs remove excess glucose in the urine and lower hba1c. Canagliflozin and renal outcomes in type 2 diabetes and. Sglt2 inhibitors in diabetic kidney disease slideshare.
Sglt2 inhibitors inhibit sglt2 proteins located in the renal tubules of the kidneys which are responsible for. Invokana, farxiga, and jardiance are example of sglt2 inhibitors approved for use in the us. Find powerpoint presentations and slides using the power of, find free presentations research about sglt2 inhibitors ppt. The differential equations describing the system sglt2sglt2i will make even the hard core urea kineticists run for cover not shown to protect the innocent 47. Sglt2 inhibitors and mechanisms of cardiovascular benefit. Sglt2 inhibitors may predispose to ketoacidosis article pdf available in the journal of clinical endocrinology and metabolism 1008. Sglt2 inhibitors metabolic effects in health and disease ppt presentation summary.
Blood glucose and blood pressure control reduce the risk of developing this complication. Six large databases were searched from inception to may 2018. Information on this fascinating and exciting class of medications has profound implications for patients with kidney disease, especially those with diabetes. The major update to this figure from 2012 is the inclusion of the sglt2 inhibitors. Dec 26, 2019 2020 ada guidelines include sglt2 inhibitors, glp1 receptor agonists to treat comorbidities gianna melillo although there were many updates in various facets of diabetes care, one change stood out. Decreased sympathetic outflow from the brain to the kidney alters the pressurenatriuresis relationship so that the kidneys excrete more sodium and. The united states food and drug administration has expanded the regulatory label for empagliflozin and canagliflozin for use to lower. Sglt2 inhibitors reduces glucose sugar levels in your body by increasing the amount of sugar you pass in your urine canagliflozin invokana, dapagliflozin forxiga, empagliflozin jardiance canagliflozin 100 mg may be increasedto 300 mg your dose may depend on your kidney function dapagliflozin 5 mg may be increasedto 10 mg. The first in class empareg outcome trial, which was designed according to the 2008 us fda regulations to assess cardiovascular safety and not benefit, compared two doses of empagliflozin 10 and 25 mgd with placebo on cardiovascular events in 7020 patients with t2d, established cvd, and egfr30.
Sglt2i sodium glucose like transporter 2 inhibitor. Jul 14, 2015 recently, several sglt2 inhibitors that block glucose reabsorption in the proximal tubule via the sodiumdependent glucose transporter have been approved for the treatment of type 2 diabetes. The first in class empareg outcome trial, which was designed according to the 2008 us fda regulations to assess cardiovascular safety and not benefit, compared two doses of empagliflozin 10 and 25 mgd with placebo on cardiovascular events in 7020 patients with t2d, established cvd, and egfr30 mlmin per 1. In most cases, sglt2 inhibitors are used in addition to other diabetes. Sharing slides related to emerging data for sglt2 inhibitors. Sglt2 inhibitors is a prescription drug class used to treat people with type 2 diabetes. Sglt2 inhibitors the johns hopkins patient guide to diabetes. Practical guide to prescribing sodiumglucose cotransporter 2. In this subset of their series, the role of the kidneys is examined and the effects of sglt2 inhibitors is explained.
Cardiovascular disease cvd, including heart failure hf, is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus t2dm. Sodiumglucose co transporter 2 inhibitors sglt2i are the latest class of antidiabetic. The similar rates of amputation and fracture that we observed with canagliflozin and placebo are reassuring and consistent with trials of other sglt2 inhibitors 6,7,20 but differ from the canvas. Sglt2 inhibition seemingly improves renal and cardiovascular outcome. Additionally, sglt2 inhibitors have been studied in combination with insulin therapy median or mean daily doses 60 units, which yielded further reductions in hba1c of 0. It is well documented that ketone bodies are elevated in patients treated with sglt2 inhibitor. Common side effects of sglt2 inhibitor are kidney problems, flulike symptoms, constipation, nasal congestion, and urinary tract infections. Sglt2 inhibitors and the diabetic kidney diabetes care 2016. Future studies for renal outcomes with sglt2 inhibitors 32 dapa ckd 2020 empa kidney 2022 33 recite patient counseling points for sglt2 inhibitors prevention of akiwith sglt2 inhibitors avoid sglt2 inhibitors in patients with egfr inhibition. Sglt2 inhibitors reduce central sympathetic overactivity, probably by suppressing renal afferent signaling to the brain.