SGLT-2 Inhibitors: Turning Point in Diabetes Treatment

Diabetes is a complex endocrine and metabolic disorder affecting more than 300 million people globally, and its prevalence is increasing. Left uncontrolled, this disease can result in microvascular and macrovascular complications.

While there is a wide range of pharmacotherapies for diabetes, current therapies target a lack of insulin secretion and/or an increase in insulin resistence. Despite the availability of these therapeutic agents, many patients fail to achieve or maintain target glucose levels.

The introduction of sodium glucose transporter 2 (SGLT-2) inhibitors has marked a turning point in the management of patients with both type 1 and type 2 diabetes. This class of drug includes canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) and is commonly referred to as gliflozins.

Gliflozins work independent of insulin by reducing reabsorption of glucose by the proximal tubules of the kidneys, thereby increasing urinary excretion of glucose. SGLT-2 inhibitors used alone or in combination therapy have demonstrated efficacy in reducing glycated hemoglobin A1C (HbA1C) levels from 0.5% to 1.5%, favorable effects on weight and blood pressure, and a low incidence of hypoglycemia.

SGLT-2 inhibitors have excellent oral availability, a long half-life, no active metabolites, and a limited propensity for drug-drug interactions. They are dosed once daily and require dose reductions based on kidney function.

Diabetes and related comorbidities account for more than 60% of the world's annual deaths and an economically crippling burden of lost productivity. Even though there is indisputable evidence of this, the global response still borders on apathy. Diabetes remains disproportionally underfunded and the harsh reality is that there is very little coordinated care going on in the United States regarding diabetic patient management.

As this field progresses, monitoring patient response and managing adverse effects to therapy must become a coordinated effort among physician, nurse, patient, and pharmacist. Patient education and consistent monitoring of blood glucose levels and signs of adverse effects are critical to ensure optimal outcomes.