SGLT2 inhibitors better than the rest?

This article reviewed the risks and benefits of SGLT2 inhibitors such as dapagliflozin (Forxiga) and canagliflozin (Invokana) in the treatment of type 2 diabetes mellitus (T2DM).

SGLT2 inhibitors are a newly developed class of anti-diabetes drugs that cause more glucose to be eliminated from the blood through the urine. Normally, the kidneys take up (reabsorb) glucose from the urine, sending it back into the bloodstream. Glucose reabsorption in the kidneys is controlled by a protein called the sodium glucose co-transporter 2 (SGLT2). Studies have shown that SGLT2 levels are higher in patients with T2DM. Therefore, SGLT2 inhibitors, which block this protein and stop glucose reabsorption, have emerged as a possible treatment for T2DM. However, information regarding the use of SGLT2 inhibitors is still limited, and SGLT2 inhibitors are not yet routinely prescribed to diabetic patients.

This review analyzed 58 studies, including more than 17,000 diabetic patients. The studies investigated the effect of SGLT2 inhibitors, compared to a placebo (a substance with no medical effect used as a control), or to other anti-diabetic drugs such as metformin (Glucophage) and sitagliptin (Januvia).

Overall, patients treated with SGLT2 inhibitors showed significantly reduced HgbA1c levels (an indicator of average blood glucose levels over the last 3 months) compared to patients treated with a placebo and to those treated with other medications. In addition, SGLT2 inhibitors were found to be associated with reduced body weight and blood pressure compared to other anti-diabetic drugs.

However, SGLT2 inhibitors were associated with several side effects such as an increased risk of genital and urinary infections. Dapagliflozin was also shown to be associated with an increased risk of breast and urinary-bladder cancers. No increased risk for hypoglycemia (dangerously low blood glucose levels) was associated with the use of SGLT2 inhibitors compared to other anti-diabetic drugs.

This review concluded that SGLT2 inhibitors can be an effective treatment for T2DM, while reducing unwanted risk factors such as weight gain and high blood pressure. However, further investigation into the long-term effects of SGLT2 inhibitors is needed.

There was a significant amount of missing data on patients' blood glucose measurements and characteristics in many of the trials reviewed. In addition, most of the trials were funded by pharmaceutical companies manufacturing SGLT2 inhibitors. These factors may have significantly influenced the reported results. Furthermore, none of the trials discussed the long term effects and efficiency of SGLT2 inhibitors. As of January 2014, dapagliflozin, an SGLT2 inhibitor, is approved by the FDA  for the management of type 2 diabetes.

Consult with your physician regarding the risks and benefits of new SGLT2 inhibitors in the treatment of diabetes.