SGLT2 inhibitors inhibit reabsorption of approximately 30–50 per cent of the glucose filtered by the kidneys and thereby increase urinary glucose excretion, reducing hyperglycaemia anywhere from 1–5 per cent from baseline. As they act independently of insulin there is very low risk of hypoglycaemia, so they can be used as monotherapy or in combination with other agents.
Dramatic beneficial cardiovascular outcomes5
Studies into SGLT2 inhibitors report a lower risk of stroke, heart attack, heart failure hospitalisation, and death from CVD in people with type 2 diabetes.
The actual mechanism(s) responsible for these beneficial effects is not completely clear; many mechanisms have been proposed, including lowering blood pressure, inhibiting the sympathetic nervous system and reducing inflammation.
Promote weight loss and minimise weight gain
SGLT2 inhibitors can induce weight loss of 2–3kg, with a fast decline of 1–2kg in the first weeks which may be the result of acute osmotic diuresis by blockade of the SGLT2 receptor.
Thereafter, body weight declines more gradually over 20 weeks, which can be related to reductions
in fat mass, and then reaches a plateau phase. Clinical data up to four years show that bodyweight reduction with SGLT2 inhibitors is maintained.
Slow the progression of kidney disease6
CKD occurs in approximately 40 per cent of people with type 2 diabetes. Diabetes is the leading cause of CKD globally, accounting for nearly half of all cases of kidney failure requiring replacement therapy.
SGLT2 inhibitors improve glomerular haemodynamic function and are thought to ameliorate other local and systemic mechanisms involved in the pathogenesis of CKD.
The kidney benefits of SGLT2 inhibitors appear to be largely independent of glycaemic control, ie, they are beneficial for those with or without well--controlled glycaemia.