SGLT-2 inhibitors

Additionally, as diabetes management has evolved, other classes of medications, such as metformin and newer drugs like SGLT-2 inhibitors and GLP-1 receptor agonists, have become more commonly prescribed due to their different mechanisms of action and potentially fewer side effects. Some SGLT2 inhibitors are also FDA-approved for use in people with chronic kidney disease (CKD) and/or heart failure to lower the risk of heart attack, stroke, and/or heart failure flare-ups, including in people who do not have diabetes. Some SGLT2 inhibitors are FDA approved to help slow the progression of kidney disease.

SGLT2 stands for Sodium-Glucose Cotransporter 2, and it refers to a specific type of protein found in the kidneys. SGLT2 plays a crucial role in the reabsorption of glucose (sugar) from the urine back into the bloodstream. SGLT2 inhibitors lower blood sugar by causing the kidneys to remove sugar from the body through urine. In people with diabetes, especially type 2 diabetes, the SGLT2 protein can be targeted as a way to lower blood sugar levels. Here’s some important information about SGLT2 inhibitors:

Mechanism of Action: SGLT2 inhibitors are a class of medications used to treat type 2 diabetes. They work by blocking the action of SGLT2 proteins in the kidneys. By inhibiting SGLT2, these medications prevent the reabsorption of glucose from the urine, leading to increased urinary glucose excretion. This results in lower blood sugar levels.
Indications: SGLT2 inhibitors are typically prescribed to people with type 2 diabetes whose blood sugar levels are not adequately controlled with lifestyle changes, diet, and exercise alone. They are usually used in combination with other diabetes medications or as part of a comprehensive treatment plan.
Common SGLT2 Inhibitors: Some examples of approved medicines in the SGLT2 inhibitor class include:

Brenzavvy™ (bexaglifloxin)
Invokana® (canagliflozin)
Farxiga® (dapagliflozin)
Jardiance® (empagliflozin)
Steglatro® (ertugliflozin)

All SGLT2 inhibitors work in relatively the same way and are taken orally (by mouth).

Benefits:

Blood Sugar Control: SGLT2 inhibitors can lower blood sugar levels by increasing the excretion of glucose in urine.
Weight Loss: Some people may experience weight loss while taking SGLT2 inhibitors due to the loss of calories through increased urinary glucose excretion.
Blood Pressure: These medications may also have a modest blood pressure-lowering effect.

Side Effects: Common side effects of SGLT2 inhibitors may include urinary tract infections (UTIs), genital yeast infections, increased urination, and thirst. More severe side effects can include ketoacidosis (a rare but serious condition characterized by high levels of blood acids called ketones) and dehydration.Low risk of hypoglycemia is associated with the use of SGLT2 inhibitors. Only when used as an add-on to Sulfonylureas does the higher frequency of hypoglycemic episodes become evident.
Precautions: SGLT2 inhibitors should be used with caution in individuals with impaired kidney function, and dosage adjustments may be necessary in such cases. Patients should also be educated about the signs and symptoms of ketoacidosis.
Cardiovascular Benefits: Some SGLT2 inhibitors have shown cardiovascular benefits by reducing the risk of heart-related events in people with diabetes, including heart attacks and strokes.
Kidney Protection: SGLT2 inhibitors may slow the progression of kidney disease in people with diabetes.

Contraindicated in patients with severe renal impairment and those with ketoacidosis is this class of drugs.

Empagliflozin

Empagliflozin belongs to SGLT2 inhibitors class of medicine.

It inhibits the reabsorption of glucose in the proximal tubules causing glycosuria. The excess glucose in the urine also causes water loss from the body which helps in reducing blood pressure. It has been shown to be effective in reducing cardiovascular mortality in patients with chronic heart failure, apart from its role in diabetes.

It should be prescribed in the early morning as 10 mg tablets once daily. The dose may be increased to a 25mg/ day if the target glycemic target is not achieved and the drug is well tolerated by the patient.