SGLT2 inhibitors

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SGLT2 inhibitors are a class of diabetes medication prevents the body to reabsorb glucose, increasing glucose excretions in urine to lower blood-glucose level.

SGLT2 inhibitors

SGLT2 inhibitors are sodium-glucose co-transporter 2 (SGLT2) inhibitors; it blocks the reabsorption of glucose into body by the kidney and increasing glucose excretions in urine. It is not recommendable for patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.

SGLT2 inhibitors mechanism of action

SGLT2 is a protein in humans that facilitates glucose reabsorption in the kidney. SGLT2 is responsible for almost 90% of the glucose reabsorption in the kidney. Inhibiting this transporter leads to the decrease in blood glucose due to the increase in renal glucose excretion.

The mechanism of action of this new class of drugs also offers further glucose control by allowing increased insulin sensitivity and uptake of glucose in the muscle cells, decreased gluconeogenesis and improved first phase insulin release from the beta cells.

Drugs in the SGLT2 inhibitors class

  • Generic name: Canagliflozin (Brand name: Invokana),
  • Generic name: Dapagliflozin (Brand name: Farxiga (in US), Forxiga (in EU)),
  • Generic name: Ipragliflozin (Brand name: Suglat)

SGLT2 inhibitors dosage

  • Canagliflozin – start with a minimum dose of 100 mg once daily for eGFR 45 to < 60 mL/min/1.73 m2, maximum dose of up to 300 mg once daily is allowable for patients with eGFR ≥60 mL/min/1.73 m2.
  • Dapagliflozin - start with a minimum dose of 5 mg orally one a day; take in the morning with or without food. You may increase to 10 mg once a day in patients tolerating 5 mg/day who have an eGFR ≥60 mL/min/1.73 m² and require additional glycemic control.
  • Ipragliflozin - The recommended dose is 50 mg once daily, in the morning. If the effects are insufficient, the dosage may increase to up to 100 mg once a day, while carefully monitoring disease progress.

SGLT2 can increase the risk of hypoglycemia when combined with insulin or an insulin secretagogue.

What you can expect from SGLT2 inhibitors?

SGLT2 inhibitors as a mono-therapy can reduce HbA1c levels. You can use SGLT2 inhibitors as a mono-therapy or in combination with most other oral diabetes drugs and insulin.

Possible side effects of SGLT2 inhibitors

SGLT2 inhibitors can increase LDL cholesterol, urinary tract infections, genital mycotic infections, and associated with increased urination and episodes of hypotension and low blood-glucose (or hypoglycemia). The same report did show that the drug decreased weight by a 1.9 to 3% as well as decreased systolic and diastolic blood pressures and raised HDL cholesterol. Some common side effects are rapid weight loss, tiredness, and dehydration.

Who should avoid using SGLT2 inhibitors?

Avoid SGLT2 inhibitors, if you are

  • Type 1 diabetes
  • People with low kidney function
  • People taking strong diuretic medication
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