pharmacist showing patient blood sugar device

SGLT2 inhibitors: A silver bullet?

September 20, 2021

by Sean S. Hong

Sodium glucose co-transporter-2 (SGLT2) inhibitors promote the kidneys to filter glucose out of the blood and excrete the glucose as waste. As a result, SGLT2 inhibitors are indicated to treat patients for type 2 diabetes as an alternative to insulin or metformin. Canagliflozin (Invokana®) was first approved as appropriate therapy by the FDA in 2013. And the list of SGLT2 inhibitors approved to treat diabetes further expanded to empagliflozin (Jardiance®), dapagliflozin (Farxiga®) and ertugliflozin (Steglatro®).

SGLT2 Inhibitors and other indications

The benefits of SGLT2 inhibitors may go well beyond diabetes, weight loss, and heart failure.
SGLT2 inhibitors have also been shown to improve outcomes in a number of other patient populations with or without diabetes. Continued studies such as the Emperor-Reduced and DAPA-HF discovered that SGLT2 inhibitors are effective at treating patients for heart failure, even if they do not have diabetes. As a result, current guidelines by the American College of Cardiology and American Heart Association reflect the efficacy of SGLT2 inhibitors as legitimate therapy for heart failure. In addition to having a cardiovascular benefit, a randomized control study published in Diabetes, Obesity and Metabolism, SGLT2 inhibitors were found to significantly reduce mortality and hospitalization in patients with end-stage renal disease and type 2 diabetes mellitus over patients who were on a DPP-4 inhibitor. Furthermore, diabetic patients on SGLT2 inhibitors were found to lose significantly more weight when compared to patients who were prescribed GLP-1 receptor antagonists.

The benefits of SGLT2 inhibitors may go well beyond diabetes, weight loss, and heart failure. According to clinicaltrials.gov, a number of clinical trials are recruiting participants to study SGLT2 inhibitors as potential treatments for polycystic ovarian syndrome, non-alcoholic steatohepatitis, prophylaxis against acute kidney injury in diabetic patients and efficacy of pre and post treatment of patients with acute myocardial infarctions undergoing percutaneous coronary intervention and are at high risk of heart failure.

Cautionary measures

We as pharmacists should always keep in mind what is best for our patients, which encompasses being cognizant of the new practice guidelines of the drugs we dispense as well as the potential risks. Though these recent developments seem encouraging we need to keep in mind that patients on SGLT2 inhibitor therapy should be counseled regarding diabetic ketoacidosis (DKA) as a potential adverse effect, a condition in which the body expends fat and produces ketones as byproduct due to the shortage of glucose in the body. This in turn increases the acidity of the blood sometimes to dangerous levels. Studies have shown patients on SGLT2 inhibitors have a three-fold increased risk of developing DKA.

Final thoughts

When penicillin was discovered almost 100 years ago, it was hailed as a game changer for antibiotic therapy in the medical world. And throughout the years beta-lactam drugs were refined to deliver a broad spectrum of usefulness and even expanded to be effective against even various gram-negative organisms. With the current trajectory of progress, can SGLT2 inhibitors become the next blockbuster drug? Only time will tell.

Sean S. Hong is a U.S. Army ROTC candidate and a fourth-year student pharmacist at the Cedarville University School of Pharmacy. Sean’s current areas of interest in pharmacy practice are trauma medicine and infectious disease with the intent of commissioning as a healthcare officer at field hospitals deployed across the world.

 

The Cedarville University School of Pharmacy is equipping its Doctor of Pharmacy students to be on the leading edge of healthcare innovation. Cedarville’s Pharm.D. students are fully prepared to begin a rewarding career as a pharmacist and to use their calling to make a difference for Christ as they serve with excellence and compassion.

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