Benefits of SGLT-2 Inhibitors Go Beyond Glycemic Control
Diabetes mellitus affects over 300 million individuals worldwide (an estimated prevalence of 6.9% to 10.2% in Western societies and 3.7% to 7.6% in developing countries).1 Type 2 diabetes (T2DM) accounts for 90% to 95% of the incidence.2 Up to 75% of adults with diabetes have comorbid hypertension.3 There is significant overlap in underlying risk factors and complications of both conditions, including disorders of microvasculature (eg, coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease) and macrovascular complications (retinopathy, nephropathy, and neuropathy).3
Current guidelines for management of T2DM recommend initial treatment with lifestyle modification, followed by metformin monotherapy.4 If glycemic targets are not met, treatment is intensified to include dual- and triple-combination therapy and insulin. But despite the availability of several antidiabetic agents, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors), only half of patients with T2DM achieve optimal glycemic control.2
Sodium-glucose cotransporter-2 (SGLT-2)-inhibitors have been added to the antidiabetic armamentarium relatively recently. SGLT-2 inhibition utilizes a novel mechanism to reduce plasma glucose concentration via inhibition of glucose reabsorption by the kidneys.2 Beyond their impact on glycemic control, SGLT-2 inhibitors also inhibit the reabsorption of sodium.2 Moreover, the release of glucose within the renal tubular lumen may further promote the excretion of sodium and water—a similar effect to that of osmotic diuretics.2 These “twin natriuretic actions” contribute to a decrease in BP.2 Three SGLT-2 inhibitors are currently approved by the US Food and Drug Administration (FDA): canagliflozin, dapagliflozin, and empagliflozin.
Studies have shown SGLT-2 inhibitors to have a beneficial effect on BP.5,6 A recent literature review of English-language articles published between 1966 and March, 2015 examined the data derived from these studies.2