Renoprotective effects of combined sglt2 and ace inhibitor. Sglt2 inhibitors inhibit sglt2 proteins located in the renal tubules of the kidneys which are responsible for. Rieg and vallon begin the series by tracing the development of the sglt inhibitor class of drugs, including sglt1 inhibitors, sglt2 inhibitors. Decreased sympathetic outflow from the brain to the kidney alters the pressurenatriuresis relationship so that the kidneys excrete more sodium and. Canagliflozin and renal outcomes in type 2 diabetes and.
Sglt2i sodium glucose like transporter 2 inhibitor. 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. The potency and positioning of sglt2 inhibitors as an antidiabetic drug are dependent on their characteristic profile, which. Apr 21, 2016 sodium glucose co transporter sglt2 inhibitors 1. 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. 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. Blood glucose and blood pressure control reduce the risk of developing this complication. The typical dose is 100 300 mg canagliflozin, 510 mg dapagliflozin, or 10 25 mg empagliflozin, depending on the patients needs. Burke department of pharmacy practice, chicago college of pharmacy, midwestern university, chicago, illinois. Sglt2 inhibitors and the diabetic kidney diabetes care 2016.
Cardiovascular disease cvd, including heart failure hf, is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus t2dm. Is an sglt2 inhibitor right for your patient with type 2. 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. Data is lacking to support use for the treatment of t1dm at this time table 2. Practical guide to prescribing sodiumglucose cotransporter 2.
All flozins are highly selective competitive inhibitors of the sglt2 transporter tubules clin pharmacokinet 2014 53. 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. In assessing the cardiovascular cv safety profiles of antidiabetic drugs. It is to be used in conjunction with diet and exercise. Sglt2 inhibitors are used in the treatment of type ii diabetes mellitus t2dm. Cvd and t2dm share common risk factors for development and progression, and there is significant overlap between the conditions in terms of worsening outcomes. 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 inhibitors reduce central sympathetic overactivity, probably by suppressing renal afferent signaling to the brain. List of sglt2 inhibitors sodiumglucose cotransporter2. Sglt2 inhibitors and mechanisms of cardiovascular benefit. An overview article pdf available in current drug safety 2 february 2018 with 1,784 reads how we measure reads.
Choice is based on patient and drug characteristics, with the overriding goal of improving glycemic control. To download this set of slides in powerpoint format. Find powerpoint presentations and slides using the power of, find free presentations research about sglt2 inhibitors ppt. Sglt2 inhibitors may predispose to ketoacidosis article pdf available in the journal of clinical endocrinology and metabolism 1008. Random effects models were used to estimate pooled relative risks. Sodium glucose cotransporter type 2 sglt2 inhibitors. Consequently, sglt2 inhibitors reduce plasma glucose insulin independently and improve insulin resistance in diabetes. Sglt2 inhibitors are a class of medicine used to lower high blood glucose levels in people with type 2 diabetes. 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. 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. The role of sglt2 inhibitors in glucose reabsporption. Notably, the glucoselowering efficacy of sglt2 inhibitors is directly related to the.
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. Pdf sglt2 inhibitors may predispose to ketoacidosis. 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. To date, various sglt2 inhibitors have been developed and evaluated in clinical studies. The faculty will address these issues and provide practice pearls for pharmacists. 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. Phlorizin isolated from the bark of apple trees is the first natural substance with sglt inhibitory activity. Written by experts in the field, this clinical handbook explores the novel sglt2 drug class for the treatment of diabetes. Nov 26, 2014 sodiumglucose cotransporter2 sglt2 inhibitors are a newly developed class of oral antidiabetic drugs oads with a unique mechanism of action. Essentials of sglt2 inhibitors in diabetes pdf download. 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. 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. View and download powerpoint presentations on sglt2 inhibitors ppt. Invokana, farxiga, and jardiance are example of sglt2 inhibitors approved for use in the us.
Staying on top of such a huge evidence base is challenging. Fda warns that sglt2 inhibitors for diabetes may result in a serious condition of too much acid in the blood. Sglt2 inhibitors the johns hopkins patient guide to diabetes. Sglt2 inhibitors is a prescription drug class used to treat people with type 2 diabetes. Methods and analysis bmj open bmj open is a medical. Sglt2 inhibitor is an abbreviation for sodiumglucose cotransporter2 inhibitors. Essentials of sglt2 inhibitors in diabetes pdf author miles fisher isbn 331943294x file size 1. 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. Information on this fascinating and exciting class of medications has profound implications for patients with kidney disease, especially those with diabetes.
They act by inhibiting sodiumglucose transport protein 2 sglt2. Sodiumglucose cotransporter2 sglt2 inhibitors are a newly developed class of oral antidiabetic drugs oads with a unique mechanism of action. Sharing slides related to emerging data for sglt2 inhibitors. It is well documented that ketone bodies are elevated in patients treated with sglt2 inhibitor. By inhibiting sglt2, these drugs remove excess glucose in the urine and lower hba1c. In this subset of their series, the role of the kidneys is examined and the effects of sglt2 inhibitors is explained. Objective to estimate the association between the use of sodium glucose cotransporter2 sglt2 inhibitors and postmarket harms as identified by drug regulatory agencies. Sglt2 inhibitors are only approved for the management of type 2 diabetes mellitus t2dm. Sglt2 inhibitors metabolic effects in health and disease ppt presentation summary. Sodiumglucose co transporter 2 inhibitors sglt2i are the latest class of antidiabetic. Large mortalitymorbidity trials in type 2 diabetes excluding ckd and hf trials empareg. Luseogliflozin is a relatively new member of this class with an ic 50 value of 2. 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 sglt2 inhibitors first arose in may 2016 when interim data from the canagliflozin cardiovascular assessment study canvas revealed a significant increase in. The major update to this figure from 2012 is the inclusion of the sglt2 inhibitors.
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. Effect of sglt2 inhibitors on cardiovascular, renal and. The united states food and drug administration has expanded the regulatory label for empagliflozin and canagliflozin for use to lower. Elevated ketone bodies with sglt2 inhibitors and in hf. Seven days of dapagliflozin treatment reduced the calculated renal threshold for plasma glucose from 196 to 22 mgdl 10. Fda warns that sglt2 inhibitors for diabetes may result in a. Six large databases were searched from inception to may 2018. Sglt2 inhibitors, also called gliflozins, are a class of medications that inhibit reabsorption of glucose in the kidney and therefore lower blood sugar.
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 in diabetic kidney disease slideshare. Common side effects of sglt2 inhibitor are kidney problems, flulike symptoms, constipation, nasal congestion, and urinary tract infections. Sglt2i empaglifozin canagliflozin dapagliflozin ertugliflozin comparator placebo placebo placebo placebo patients enrolled cvd cv risk. The treatment plan will differ for each person, but in general sglt2 inhibitors are taken once a day before the first meal. In most cases, sglt2 inhibitors are used in addition to other diabetes. A mild state of ketosis also contributes to reduction of sympathetic tone. Sglt2 inhibition in the diabetic kidneyfrom mechanisms to. Sglt2 i empaglifozin canagliflozin dapagliflozin ertugliflozin comparator placebo placebo placebo placebo patients enrolled cvd cv risk.