diabetes mellitus
Research
Treatment
Source: Drugs
Large-scale analysis of sodium glucose co-transporter 2 inhibitors for type 2 diabetes
In a nutshell
This study investigated the effectiveness and safety of sodium glucose co-transporter 2 inhibitors in the treatment of type 2 diabetes.
Some background
Sodium glucose co-transporter 2 inhibitors (SGLT2Is), such as dapagliflozin (Farxiga), canagliflozin (Invokana) and empagliflozin (Jardiance), are used to treat type 2 diabetes (T2D). SGLT2Is target glucose (sugar) filtration by the kidneys, increasing the amount of glucose excreted through urine.
Studies have shown that SGLT2Is are effective at lowering blood glucose. However treatment with SGLT2s is associated with unwanted side effects such as urinary tract infections and genital tract infections (in females). Caution has been advised for treatment of the elderly with SGLT2Is and the effect of SGLT2Is on cardiovascular (heart) risk is unknown.
Methods & findings
This study aimed to combine and analyze the results of over 20 several clinical trials in order to assess the effectiveness and safety of SGLT2Is in the treatment of T2D.
SGLT2Is showed consistent significant reductions in blood glucose levels and body weight. Dapagliflozin, for example, lowered HbA1c (average blood glucose over 3 months) levels by 0.53% more than did a placebo (substance with no effect on the body used as a comparison). Treatment with SGLT2I was associated with a similar (low) risk of low blood sugar in comparison with most other drugs used in the treatment of T2D.
Patients being treated with dapagliflozin saw an increased rate of urinary tract infections (4.3-5.7%) compared to patients receiving a placebo (3.7%). The risk was slightly increased in men receiving canagliflozin (5-7%) compared to placebo. Treatment with empagliflozin is associated with a 3.31 times higher risk of developing genital tract infections. Patients treated with dapagliflozin and canagliflozin also reported an increased rate. Females were found to be at higher risk than males.
A number of studies investigated the effects of SGLT2Is on T2D patients with chronic kidney disease (CKD). Both canagliflozin and empagliflozin were well tolerated by patients with stage 3 CKD, and led to significant reductions in blood sugar levels. Canagliflozin also reduced body weight and blood pressure. Dapagliflozin did not improve blood glucose levels, but was well tolerated and significantly reduced body weight and blood pressure in patients with stage 3 CKD.
Two of the studies analyzed examined the use of canagliflozin in elderly T2D patients. These patients were not at higher risk of unwanted side effects compared to younger patients. The effect of SGLT2Is on blood pressure remains unclear. While a decrease in cardiovascular risk was found with the use of dapagliflozin, an increase in the risk of low blood pressure has been associated with SGLT2Is.
The bottom line
The authors concluded that SGLT2Is are effective at lowering blood glucose and are safe overall with a low risk of low blood sugar events. However, the authors point out that these drugs are associated with higher incidences of urinary tract infections and genital tract infections.
The fine print
Dosage restrictions are advised for patients with chronic kidney disease being treated with SGLT2Is. Furthermore, the authors point out that the decision to treat elderly patients with SGLT2Is should be reviewed on a case by case basis. Also, further studies are required to assess the effects of SGLT2Is on cardiovascular risk.
What's next?
Consult your doctor if you are concerned about any of the side effects of sodium glucose co-transporter 2 inhibitors.
Disclaimer:
This information should not be relied upon as a substitute for personal medical advice, diagnosis or treatment. Use the information provided by Medivizor solely at your own risk. Medivizor makes no warranties or representations as to the accuracy of information provided herein. If you have any concerns about your health, please consult a physician.
Facebook
Twitter
Email
Share with doctor
that is how we figured out I needed to go onto insulin shot because I went in for my a1 surgar test and to let her know I thought I had a yeast infesction or mybe a urineary tract infection and Ilet my doctor know at that time about the systems I was experiencing and she started me on a corse of Antibotics and I had to have two courses of antibotics before It went away and I was also give a topical cream to keep it away and I find that about once a week I find my self using that at least once a week to be able to keep the ictcy 's on the outside away. Reply
I,m on pills and insulin Novolog 30/70 I take 2 shots a day.But I can.t afford it. My husband is also on insulin, Reply
Frank if you go plant based with your diet you wont need as much insulin possibly none so check out dr Mcdougall and diabetes on YouTube and he explains how it works ...I've been watching all his podcasts and following his advice and have halved my insulin and lost some weight and feel great so you may reduce your meds and your husbands too Reply
I think the lowered blood pressure is probably a result from having some weightloss and not the meds but I was asked if I wanted to go on one of those tablets because I have good kidney function and I said I want to keep my kidneys good so no thanks and the itchiness is not nice so I'll stick to my shots of insulin until my diet and weightloss is enough to come off that Reply