Key considerations in use of glp1ras and sglt2is for cv risk. Sglt2 inhibitors blocks glucose from being reabsorbed in the kidney. Sglt2 inhibitors have been shown to be effective at lowering hemoglobin a1c levels, improving weight loss and lowering. The ada recommends selecting a drug class based on specifi c effects. From a mechanistic perspective, sglt2 inhibition attenuated expected increases in renal angiotensinogen mrna. Sglt2 is a lowaffinity, high capacity glucose transporter located in the proximal tubule in the kidneys. Practical approach to initiating sglt2 inhibitors in type 2 diabetes.
As the drugs cause more glucose to be excreted in the urine, there is a higher chance of getting genital and urinary tract infections these side. Sodium glucose cotransporter type 2 sglt2 inhibitors. Sglt2 inhibitors and serious adverse events signal lower limb amputation canvas bone fracture canvas diabetic ketoacidosis case reports. Fda has issued warnings about the increased risk of dka with the use of all approved sglt2 inhibitors empagliflozin, dapagliflozin, canagliflozin sglt2 inhibitors are currently approved by the fda for use in patients with type 2 diabetes. Common side effects of sglt2 inhibitor are kidney problems, flulike symptoms, constipation, nasal congestion, and urinary tract infections. Sodiumglucose cotransporter2 sglt2 inhibitors are a newly developed class of oral antidiabetic drugs oads with a unique mechanism of action.
Nov 26, 2014 sodiumglucose cotransporter2 sglt2 inhibitors are a newly developed class of oral antidiabetic drugs oads with a unique mechanism of action. These data suggest that the benefits of sglt2 inhibitors on kidney function identified in clinical trials seem to be. Sglt2 inhibitors and combinations step therapy 1step edit objective the intent of the sglt2 sodiumglucose cotransporter 2 inhibitor step therapy st. Sodiumglucose cotransporter sglt2 inhibitors have been demonstrated to reduce cardiovascular events, particularly heart failure. Since its inception, the american association of clinical endocrinologists aace has advocated for the finest in endocrine education and stateoftheart healthcare delivery without regard to race, ethnicity, gender, age, country of origin, economic status, lifestyle. The caryl glucoside 6 dapagliflozin was identified as a potent and selective hsglt2 inhibitor which reduced blood glucose levels in a dosedependent manner by as much as 55% in hyperglycemic streptozotocin stz rats. Sodiumglucose cotransporter 2 sglt2 i nhibitors and. Ace inhibitors lower blood pressure by keeping your blood vessels relaxed. Review sglt2 inhibitors in type 2 diabetes mellitus.
They work by removing excess glucose by blocking reabsorption through the kidneys. On the other hand, sglt2 inhibitors have been reported to enhance hepatic glucose production 27, 28 by an unknown molecular mechanism. Novel treatments for the management of type 2 diabetes. Diabetes type 2 78% kidney disease 22% how is this chart calculated. References improving outcomes in diabetic kidney disease. The safety and efficacy of sglt2 inhibitors have not yet been established in the pediatric sglt2 inhibitor to be approved by the australian therapeutic goods administration tga, as a model example.
Describe the mechanism of action and efficacy of sglt2 inhibitors in the management of type 2 diabetes. They act by inhibiting sodiumglucose transport protein 2 sglt2. Use of sglt2 inhibitors in patients with type 1 diabetes is offlabel. Fda revises labels of sglt2 inhibitors for diabetes to include warnings about too much acid in the blood and serious urinary tract infections. Sglt2 inhibitors are used to treat diabetes type 2. Key considerations in use of glp1ras and sglt2is for cv. Sglt2 inhibitors and combinations step therapy and quantity. For all healthcare professionals learn how to safely use sglt2 inhibitors in your practice. Sglt2 inhibitors the johns hopkins patient guide to diabetes. History of the sglt2 inhibitor drug class diabetes in control. Fda warns that sglt2 inhibitors for diabetes may result in a serious condition of too much acid in the blood. Oral canagliflozin invokana dapagliflozin farxiga high empagliflozin jardiance sulfonylureas help beta cells in pancreas release more insulin. Sglt2 is located in the early proximal tubule, and is responsible for reabsorption of 8090% of the glucose filtered by the kidney glomerulus.
View and download powerpoint presentations on sglt2 inhibitors ppt. Sglt2 is the major cotransporter involved in glucose reabsorption in the kidney. The latest versions of adobe reader do not support viewing pdf files within. Efficacy and renal outcomes of sglt2 inhibitors in. Ahmad and others published sglt2 inhibitors therapy in type 2 diabetes mellitus find, read and cite all the research you need on researchgate. By removing glucose from the body, sglt2 inhibitors can also have benefits for weight loss. Pdf sodiumglucose cotransporter 2 sglt2 inhibitors from. List of sglt2 inhibitors sodiumglucose cotransporter2. The typical dose is 100 300 mg canagliflozin, 510 mg dapagliflozin, or 10 25 mg empagliflozin, depending on the patients needs. Pdf sglt2 inhibitors therapy in type 2 diabetes mellitus. Fralick et al observational study1 acute kidney injury case reports serious urinary tract infection case reports venous thromboembolism yu et al metaanalysis of rcts2 acute pancreatitis case reports 1. The 2007 american diabetes association ada guidelines suggest that the a1c goal for the individual patient is an a1c as close to normal sglt2 inhibitors is an ideal educational resource for busy medical professionals who need to stay uptodate with diabetes treatment advances in order to provide the best possible clinical care for their patients. Effects of sodiumglucose cotransporter2 inhibitors on.
Sodiumglucose cotransporter 2 sglt2 i nhibitors and their. Studies show sglt2 inhibitors are effective in controlling excess blood sugar in people with type 2 diabetes. Sglt2 inhibitors practice tool diabetes pharmacists network. Once patient eligibility has been determined and a decision to begin one of the suggested therapies has been made through clinicianpatient discussion including patient preference and cost consideration, this tool provides clinicians with. In patients with t2dm and ckd, sglt2 inhibitors have a decreased glucoselowering effect compared to patients without ckd. But potent blood sugar control also comes with side effects. Sglt2 inhibitors lower the amount of glucose that can be reabsorbed, i. Incretins and sglt2 inhibitors in the treatment of diabetes. This handout is in general type 2 diabetes and sick days. Sglt2 is a protein in humans that facilitates glucose reabsorption in the kidney. Since its inception, the american association of clinical endocrinologists aace has advocated for the finest in endocrine education and stateoftheart healthcare delivery without regard to race, ethnicity, gender, age, country of origin, economic status, lifestyle, sexual orientation or domestic living arrangements.
Sglt2 inhibitors and combinations step therapy and. Arbs keep the blood vessels open and relaxed to help lower blood pressure. Sglt2 inhibitors are associated with a substantial reduction in albuminuria and reduced risk of progression to albuminuria. In most cases, sglt2 inhibitors are used in addition to other diabetes. When untreated, type 2 diabetes can lead to serious problems, including blindness, nerve and kidney.
Do not take any products that contain nonsteroidal antiinflammatory drugs such as ibuprofen advilmotrin or naproxen aleve. Pathogenesis of type 2 diabetes the ominous octet adapted from. Oral chlorpropamide diabinese low glimepiride amaryl glipizide glucotrol glucotrol xl glyburide glibenclamide micronaseglynase. Cohort study of serious adverse events with sodiumglucose. Invokana, farxiga, and jardiance are example of sglt2 inhibitors approved for use in the us. Review safety and contraindications for sglt2 inhibitors. Sglt2 inhibitors on cv outcomes and allcause mortality in type 2 diabetes and chronic kidney disease gfr inhibitors in the treatment of type 2 diabetes mellitus t2dm and recognize when dose adjustments and drug monitoring are warranted. Sglt2 inhibitors block the reabsorption of glucose in the kidney, increase glucose excretion, and lower blood glucose levels. It is to be used in conjunction with diet and exercise. Apart from blood sugar control, gliflozins have been shown to provide significant cardiovascular. Sodiumglucose cotransporter 2 inhibitors sglt2i are the latest class of antidiabetic. Sglt2 inhibitors block sglt2 and stop the reabsorption of glucose in the kidneys. Sglt2 inhibitors and cv safety patient doctor hospital cost off tgi06t6ffects robert chilton do, facoi, faha, facc professor of medicine cardiology university of texas health science center san antonio, texas associate program director interventional cardiology director catheterization lab ut clinical proteomics.
Sglt2 inhibitors inhibit sglt2 proteins located in the renal tubules of the kidneys which are responsible for reabsorbing glucose back into the blood. Sglt2dependent stimulation of somatostatin secretion. Phuong nguyen, pharmd candidate, lecom college of pharmacy remarkable as it might sound, the sglt2 inhibitor drug class arguably dates back 178 years. Choose a file or files to attach file types accepted. Sglt2 inhibitors have been shown to be effective at lowering hemoglobin a1c. Fda warns that sglt2 inhibitors for diabetes may result in a. Fda warns that sglt2 inhibitors for diabetes may result in. Sodiumglucose cotransporter 2 sglt2 inhibitors from natural products. In this large, international, realworld study of patients with type 2 diabetes, initiation of sglt2 inhibitor therapy was associated with a slower rate of kidney function decline and lower risk of major kidney events compared with initiation of other glucoselowering drugs. Recall the mechanism of action of sglt2 inhibitors. Care, sglt2 inhibitors are an adequate agent to add on to metformin for combination therapy. It has been reported that sodiumglucose cotranporter2 sglt2 inhibitors stimulate glucagon secretion both in vitro and in. March 18, 2017 american diabetes association 2017 professional diabetes education conference steven b. Guidelines american association of clinical endocrinologists.
Apply the pharmacists role in ensuring appropriate use of these novel treatment options. In the present study, we investigated the impact of sglt2 inhibitor therapy on serum fabp4 level in patients with. Therapie des typ2diabetes deutsche diabetes gesellschaft. Sglt2 inhibitors are used in the treatment of type ii diabetes mellitus t2dm. They also help protect your kidneys and reduce your risk of heart attack and stroke. In 2017, the american diabetes association ada standards of medical care in diabetes included the sodiumglucose cotransporter 2 sglt2 inhibitors in the management algorithm for t2dm. As expected, the frequency of amputations in reports filed for non sglt2 inhibitor drugs with the diabetes indication was three times higher than in reports without the diabetes indication. Find powerpoint presentations and slides using the power of, find free.
Sglt2 is a member of the sodium glucose cotransporter family which are sodiumdependent glucose transport proteins. Instead, the kidneys get rid of glucose through urine. In the context of sglt2 inhibition, there is considerable overlap. The faculty will address these issues and provide practice pearls for pharmacists. Pdf type 2 diabetes mellitus is a chronic metabolic disease associated with high cardiovascular cv risk. Pdf sglt2 inhibitors may predispose to ketoacidosis. As sglt2 inhibitors are indicated for diabetes treatment and diabetes is a major risk factor for amputation, we filtered the search by diabetes indication. Avoid therapy with sglt2 inhibitors with insulin in patients on a very low carbohydrate diet or with excess alcohol intake. Sglt2 inhibitors help to remove glucose from the blood and therefore help to lower blood glucose levels. As expected, the frequency of amputations in reports filed for nonsglt2 inhibitor drugs with the diabetes indication was three times higher than in reports without the diabetes indication.
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. It has been reported that sodiumglucose cotranporter2 sglt2 inhibitors stimulate glucagon secretion both in vitro and in vivo 25,26,27. Apr 28, 2016 sglt2 inhibitors decrease blood glucose level through increased glucose excretion in urine. Upon completion of this article the learner should be able to. Sglt2 inhibitors and mechanisms of cardiovascular benefit.
Efficacy and renal outcomes of sglt2 inhibitors in patients. A literature search of medline and cochrane databases was performed from 2000 to august 2018 using search terms. Sodiumglucose cotransporter2 sglt2 inhibitors gliflozins in adults with type 2 diabetes t2dm there are currently four sglt2 inhibitors canagliflozin, dapagliflozin, empagliflozin and ertugliflozin licensed in the uk for the management of adults with t2dm. Food and drug administration fda warned people with diabetes who take blood sugarlowering drugs called sglt2 inhibitors, saying they should watch for signs of a lifethreatening condition called diabetic ketoacidosis. Sglt2 inhibitors is a prescription drug class used to treat people with type 2 diabetes. Ace inhibitors prevent a hormone from forming in your body and narrowing your blood vessels. Sglt2 inhibitors are a class of prescription medicines that are fdaapproved for use with diet and exercise to lower blood sugar in adults with type 2 diabetes.
Sglt2 inhibitors, also called gliflozins, are a class of medications that inhibit reabsorption of glucose in the kidney and therefore lower blood sugar. Sglt2 inhibitors and amputations in the us fda adverse event. Sglt2 inhibitors and amputations in the us fda adverse. No head to head trials between the sglt2 inhibitors have been conducted. Utilize monitoring parameters for the sglt2 inhibitors in special populations. As a result, more glucose is excreted in the urine. Kidney outcomes associated with use of sglt2 inhibitors in. Find powerpoint presentations and slides using the power of, find free presentations research about sglt2 inhibitors ppt. These findings, combined with a favorable adme profile, have prompted clinical evaluation of dapagliflozin for the treatment of type 2 diabetes.
Jan 11, 2019 sglt2 dependent stimulation of somatostatin secretion. The safety and efficacy of sglt2 inhibitors have not yet been established in the pediatric pdf available in the journal of clinical endocrinology and metabolism 1008. The treatment plan will differ for each person, but in general sglt2 inhibitors are taken once a day before the first meal. A number of other sglt2 inhibitors are under investigation, including empagliflozin, canagliflozin and ipragliflozin. Discovery of nextgeneration antihyperglycemic agents.
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