SGLT2 Inhibitors: Little Information on Use in African Americans

With accumulating data indicating that sodium-glucose cotransporter 2 (SGLT2) inhibitors have positive effects on several cardiovascular risk factors, the race is on to determine if specific population effects exist. In populations that are disproportionately affected by diabetes, hypertension, and kidney disease—especially in African Americans—it's essential to know if these drugs offer an advantage.

The journal Postgraduate Medicine has published a new article that examines the use of SGLT2 inhibitors in the African American population. This population is the most likely to have hypertension and comorbid diabetes of all populations globally.

The authors note that African American patients who develop type 2 diabetes may present with atypical signs and symptoms. Often, their diabetes is ketosis-prone and their presenting symptoms may include severe hyperglycemia or ketoacidosis. They may need intensive insulin therapy or aggressive use of multiple agents. Up to two-thirds of African American patients who have diabetes have abnormal insulin sensitivity.

With 3 SGLT2 inhibitors now approved for use in the United States and a proven track record of predictable glycated hemoglobin (HbA1_c) reductions, SGLT2 inhibitors have become standard of care.

Among the positive effects reported in this review are positive findings in:

• Cardiovascular outcomes. Patients treated with SGLT2 inhibitors have significantly lowered risk of MACE and hospitalization for heart failure. (MACE is the composite of CV death, non-fatal myocardial infarction [excluding silent myocardial infarction], or non-fatal stroke, also called "3-point major adverse CV events.) African American patients accounted for only 5% of patients treated in the clinical trials. Thus, subgroup analysis is not possible at this time.
• Renal effects. Studies indicate the SGLT2 inhibitors appear to slow kidney disease progression. Again, the sample size for African American patients was too low to generalize this finding to this population.
• Weight loss. Use of SGLT2 inhibitors has been associated with some weight loss.

The authors indicate that since African American individuals have increased presence of cardiovascular disease and its risk factors, tend to develop more renal and parent impairment than other patients, and are highly likely to use antihypertensive medication with their glucose lowering agents, SGLT2 inhibitors appear to be a reasonable intervention.

The researchers concluded that clinicians should be careful about concurrent use of RAAS blockers with SGLT2 inhibitors, as the combination may increase risk of volume depletion. They also urge clinicians to remind patients that they need to stay adequately hydrated at all times.

Although little direct evidence of SGLT2 inhibitors' specific benefits in African American populations is available at this time, studies are underway to determine their unique properties in this population.

Reference

Kountz DS. The use of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and hypertension: a focus on African American populations. Postgrad Med. 2017 Mar 29. doi: 10.1080/00325481.2017.1313074. [Epub ahead of print].