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  • Writer's pictureDr. Mansur Shomali

SGLT2 inhibitors

New diabetes medications lower blood sugar and risk for heart attacks, and help with weight loss.

There are over a hundred different medications that can be used to treat people with type 2 diabetes.

Today, I’d like to focus on a class of medications known as SGLT2 inhibitors. SGLT2-I is an abbreviation for Sodium GLucose Transport type 2-Inhibitors.

The drugs in this class all work by forcing extra blood glucose (blood sugar) from the blood stream into the urine and thus lower the glucose in people with diabetes.

Here is a list of the SGLT2-1’s approved in the U.S. and Canada.

Non-brand name Brand name

canagliflozin Invokana

dapagliflozin Farxiga

empagliflozin Jardiance

ertugliflozin Steglatro

These medications have been proven to reduce blood glucose and A1C in people with type 2 diabetes. They may be used alone or in combination with other diabetes medications such as metformin. Clinicians are really excited because these drugs have been shown to have important benefits other than just lowering glucose.

In a study that looked at treating people with Jardiance for their diabetes as compared to other diabetes medications, the people taking Jardiance were 38% less likely to die from a heart attack or stroke. In addition, they were 35% less likely to be hospitalized with heart failure. In a study that looked at people with diabetes and kidney disease, people taking Invokana had a 30% reduction in worsening kidney disease.

Since the most common complications of diabetes include heart disease and kidney disease, to have medications that not only lower glucose but also treat or prevent those other conditions is very valuable.

Summary of Potential Benefits of SGLT2 inhibitors

· Weight loss

· Lower blood glucose without causing hypoglycemia (low blood sugar)

· Prevent heart attacks and strokes

· Reduce the risk of heart failure

· Reduce the progression of kidney disease

Potential Side Effects

There are no perfect medications. The most common side effects that I see in my practice are:

· Increase in urination

· Increased risk of urinary tract infections

· Increased risk of vaginal yeast infections in women

Rare cases of bone fractures have been observed in people prescribed Invokana. In early studies with Invokana, foot amputations were seen and so there was a warning on the label of this medication about the amputation risk. The U.S. FDA took the amputation warning away after reviewing recent data that did not show this is a significant risk.

As with all prescription medications, discuss with your health care providers whether an SGLT2 inhibitor medication would be a good choice for you.

Links to references from The New England Journal of Medicine:

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