Using sglt2 inhibitors to help manage type 1 diabetes. The sodiumglucose cotransporter 2 sglt2 class of medications to treat type 2 diabetes just got another competitor as the fda approved ertugliflozin steglatro from merck and pfizer. Treatment with sodiumglucose cotransporter 2 sglt2 inhibitors, which reduce blood glucose levels in patients with type 2 diabetes mellitus t2dm by preventing renal reabsorption. The sodium glucose cotransporter 2 sglt2 receptor inhibitors are a new class of glucoselowering agents. View and download powerpoint presentations on sglt2 2016 ppt. Practical guide to prescribing sodiumglucose cotransporter 2. Accordingly, there is growing interest in empagliflozin and the entire sglt2 inhibitor class as drugs that could potentially change the manner in which we approach the management of hyperglycemia in patients with type 2 diabetes. Canagliflozin sglt2 inhibitors should be used with caution in individuals at risk for amputations, such as those with advanced pvd, severe peripheral neuropathy or prior history of lowerlimb amputation or foot ulceration. Sodium glucose cotransporter 2 sglt2 inhibitor is a new kind of oral antihyperglycemic drug which was approved by food and drug administration fda on march, 20 available in type 2 diabetes mellitus t2dm. What are the side effects of sglt2 inhibitors for diabetes.
Sodium glucose cotransporter type 2 sglt2 inhibitors moving beyond targets nicholas cole helbling pharmd. Sglt inhibitors in management of diabetes the lancet. Adjunctivetoinsulin therapy with sodiumglucose cotransporter 2 sglt2 inhi bition may improve glycemic control in type 1 diabetes t1d. Sglt2 inhibition in the diabetic kidneyfrom mechanisms to. Blood glucose and blood pressure control reduce the risk of developing this complication. Sglt tools allows you to find and download slides decks customized for the information you researching. A genetic model of sglt2 inhibition presentation glucosuria. Heart failure patients with diabetes and prediabetic dysglycemia have much worse outcomes than those without diabetes why. The two main sodiumglucose cotransporters sglts, sglt1 and sglt2, provide new therapeutic targets to reduce hyperglycaemia in patients with diabetes. This stepwise treatment approach better reflects guideline recommendations for the treatment of type 2 diabetes. Fda warns that sglt2 inhibitors for diabetes may result in a serious condition of too much acid in the blood. Effects of diabetes and sglt2 inhibition on nephron hemodynamics.
Sglt2 inhibitors, glp1ras recommended in type 2 diabetes and cvd. Sglt2 is located in the early proximal tubule, and is responsible for reabsorption of 8090% of the glucose filtered by the kidney glomerulus. Essentials of sglt2 inhibitors in diabetes pdf author miles fisher isbn 331943294x file size 1. We hope youll benefit from the insights and share them with your colleagues. Diabetes drugs market by historical data, segmentation, key leaders analysis, gross margin, demands forecast till 2026 2019 research report on global diabetes drugs market is a professional and comprehensive report on the diabetes drugs industry.
This was a prospective, singlecentre, placebocontrolled, doubleblind, randomised crossover phase iiib study conducted between. New sglt2 competitor steglatro approved for type 2 diabetes. To download this set of slides in powerpoint format. Rationale for sglt2 inhibition in diabetes treatment it has been known for many years that induction of glucosuria using a nonselective inhibitor of renal and intestinal glucose transport, such as phlorizin, was able to improve control of diabetes in animal models, but these nonselective inhibitors were unsuitable for clinical development as drugs. Sodiumglucose cotransporter 2 sglt2 inhibitors, the most recent glucoselowering oral. Is an sglt2 inhibitor right for your patient with type 2. They block the reabsorption of filtered glucose in kidneys. The united states food and drug administration has expanded the regulatory label for empagliflozin and. Sodiumglucose cotransporter 2 sglt2 inhibitors, also called gliflozin drugs, are a new class of diabetic medications indicated for the treatment of type 2 diabetes. Sglt2 normally reabsorbs approximately 90% of the filtered glucose load. The sodiumglucose cotransporter 2 inhibitor, dapagliflozin, has been shown to improve diabetic control and reduce blood pressure in patients with type 2 diabetes mellitus. Answer sglt2 inhibitors include canagliflozin invokana, dapagliflozin farxiga and empagliflozin jardiance.
Comparative effectiveness of sodiumglucose cotransporter 2. Diabetes mellitus is an independent risk factor for hf, 45 with studies showing that subclinical atherosclerotic and nonatherosclerotic myocardial damage occurs early in the natural history of diabetes mellitus, often before diagnosis of the condition. Connecting t2dm pathophysiology, comorbidities, and sglt2 inhibitors. Sanford health largest, notforprofit rural health system in the nation. As early as 2019, the fda could approve sglt2 inhibitors for adults with type 1, but some patients are already using these pills off label. Diabetic nephropathy dn is the most common cause of endstage renal disease worldwide. Sep 17, 2017 sglt2 inhibitors in diabetic kidney disease 1. The resulting decrease in atp release from the basolateral membrane of tubular epithelial cells reduces production of. The faculty will address these issues and provide practice pearls for pharmacists. Term noncardiovascular safety, and efficacy of sodiumglucose cotransporter 2 inhibitors in patients with type 2 diabetes mellitus. It is to be used in conjunction with diet and exercise. Renal gluconeogenesis, renal glucose uptake and tubular glucose reabsorption are the three ways of renal. Find powerpoint presentations and slides using the power of, find free presentations research about canagliflozin ppt. Effects of sodium glucose contransporter sglt2 inhibition on renal outcomes in patients with diabetic chronic kidney disease.
Common side effects of sglt2 inhibitor are kidney problems, flulike symptoms, constipation, nasal congestion, and urinary tract infections. Written by experts in the field, this clinical handbook explores the novel sglt2 drug class for the treatment of diabetes. They have also been found to show cardiac benefits in patients with diabetes, and are being studied for possible use in type 1 diabetes. The role of the kidney in blood glucoselevel regulation was until recently underestimated. Although the presentation of two cases of diabetic ketoacidosis did not. Sodiumglucose cotransporter 2 sglt2 inhibitors block the sglt2 transporter in the proximal renal tubule resulting in glucosuria and natriuresis and are approved and indicated for type 2 diabetes. Apr 21, 2016 conclusions sglt2 inhibitors are a new option in treatment for type 2 diabetes insulin independent mechanism of action allows use in early and late stages of diabetes weight loss is a desirable side effect long term outcome studies are necessary to assess risk of cardiovascular events 72015 24 25. The sodiumglucose cotransporter 2 sglt2 inhibitors are a class of glucoselowering therapies that have been shown to reduce risks of heart failure hf events in patients with type 2 diabetes mellitus t2dm at highrisk for or with cardiovascular disease. Sglt2 inhibitors and the diabetic kidney diabetes care. The major update to this figure from 2012 is the inclusion of the sglt2 inhibitors. Sglt2 inhibition seemingly improves renal and cardiovascular outcome. Home journal of the american heart association vol.
You are free to use the slides in presentations without further permission as long as the slide content is not altered in any way and appropriate attribution is made to the american diabetes association the association name and logo on the slides constitutes appropriate. Sglt2 inhibitors lower blood glucose by increasing urinary glucose excretion. View and download powerpoint presentations on canagliflozin ppt. Pdf the safety and efficacy of sglt2 inhibitors in diabetes. Dec 26, 2019 although there were many updates in various facets of diabetes care, one change stood out. Heart failure is the most disabling and deadly complication of diabetes patients with both conditions do especially badly. Sglt2 inhibitors gliflozins diabetes uk, uk diabetes. Observe 4d does give us some reassurance that in the usual patients with type 2 diabetes, amputations is not a major problem for patients treated with sglt2 inhibitors, buse noted. Sglt2 inhibitors are a class of prescription medicines that are fdaapproved for use with diet and exercise to lower blood sugar in. A randomised study of the impact of the sglt2 inhibitor. These drugs have received special attention because they decrease the risk of major.
New recommendations call for 2 drug classes to be used to treat patients with type 2 diabetes t2d and. Reducing the amount of glucose being absorbed in the kidneys so that it is passed out in the urine. Diabetes in control is pleased to provide you with the latest insights and information on the sodiumdependent glucose transporter two sglt2 drug class to help optimize your practice. Sglt2 inhibitors in the management of type 2 diabetes. Its effects on micro and macrovascular structure and function have not yet been reported. Sglt2 inhibitors for treatment of type 2 diabetes see more sglt2 resources. Preventing and treating heart failure with sodiumglucose co.
Sglt2 is responsible for reabsorption of most of the glucose filtered by the kidney. Sglt2 inhibitors provide multiple benefits, including decreased hba1c, body weight, and blood pressure. In general, the clinician should consider one of 6 treatment options combined with metformin i. Staying on top of such a huge evidence base is challenging. Information on this fascinating and exciting class of medications has profound implications for patients with kidney disease, especially those with diabetes. Thanks for all youre doing to improve your patients lives and longevity. The united states food and drug administration has expanded the regulatory label for empagliflozin and canagliflozin for use to lower. The first in class empareg outcome trial, which was designed according to the 2008 us fda regulations to assess cardiovascular safety and not benefit, compared two doses of empagliflozin 10 and 25 mgd with placebo on cardiovascular events in 7020 patients with t2d, established. Read now create download for free ebook rilisetopfree. Here we give an overview of the trials published so far, and outline those still in progress. Dec 21, 2017 the sodiumglucose cotransporter 2 sglt2 class of medications to treat type 2 diabetes just got another competitor as the fda approved ertugliflozin steglatro from merck and pfizer. Ppt sglt2%20inhibitors powerpoint presentation free.
However, the most clinically relevant issue to help position sglt2 inhibitors in the increasing range of glucoselowering medications is to compare their e. In patients with type 2 diabetes mellitus, in whom renal glucose reabsorption might be upregulated, orally active, selective sglt2 inhibitors improve glycaemic control to a therapeutically useful. Euglycemic diabetic ketoacidosis sometimes seen with sglt2. Diabetic ketoacidosis dka in patients with presenting serum blood glucose diabetes in conjunction with starvation and acute illness. Theyve been around for a couple of years, and so the easiest way to think about them, in terms of mechanism of action is they promote glycosuria. Cardiac and renal effects of sglt2 inhibitors in diabetes. New sglt2 class of diabetes drug may have paradoxical effect.
Sharing slides related to emerging data for sglt2 inhibitors information on this fascinating and exciting class of medications has profound implications for patients with kidney disease, especially those with diabetes. Most of the remaining glucose absorption is by sodiumglucose cotransporter 1 sglt1 in more distal sections of the proximal tubule. The report monitors the key trends and market drivers in the current scenario and offers ontheground insights. Type 2 diabetes mellitus t2dm is a rapidly growing major global health problem, leading to an increased risk of coronary and other arterial events, heart failure hf, decline in renal function, and death. Find powerpoint presentations and slides using the power of, find free presentations research about sglt2 inhibitors ppt. Sodium glucose cotransporter type 2 sglt2 inhibitors moving beyond targets nicholas cole helbling pharmd bcps.
Diabetes is a complex, chronic medical condition affecting 29. Diabetes and heart failure heart failure is one of the most common cardiovascular complications of diabetesdiabetes is very common in heart failure. Diabetes drugs market global share, indepth analysis, sales revenue forecasts to 2026 1 2019 research report on global diabetes drugs market is a professional and comprehensive report on the diabetes drugs industry. Therefore, we aim to perform pairwise comparisons of the 6 sglt2 inhibitors. Apr 16, 2020 the role of the kidney in blood glucoselevel regulation was until recently underestimated.
As a primary contributor to the excess risk of allcause and cardiovascular death in diabetes, dkd is a major contributor to the progressively expanding global burden of diabetesassociated morbidity and mortality. Essentials of sglt2 inhibitors in diabetes pdf download. Sodium glucose cotransporter type 2 sglt2 inhibitors. Conclusions sglt2 inhibitors are a new option in treatment for type 2 diabetes insulin independent mechanism of action allows use in early and late stages of diabetes weight loss is a desirable side effect long term outcome studies are necessary to assess risk of cardiovascular events 72015 24 25. Sglt2 inhibitors, glp1ras recommended in type 2 diabetes. Introduction as a new class of glucoselowering drugs, sodiumglucose cotransporter 2 sglt2 inhibitors are effective for controlling hyperglycaemia, however, the relative effectiveness and safety of 6 recently available sglt2 inhibitors have rarely been studied.
Whether type 1 or type 2 diabetes, the sglt2 inhibitor can reduce insulin requirements significantly. Sodiumglucose cotransporter 2 sglt2 inhibitors represent a unique class of glucoselowering therapies that have. Sodiumglucose cotransporter 2 sglt2 inhibitors are the most recently approved class of diabetes drugs. Are sglt2 inhibitors a targeted treatment for diabetic. Multidimensional issues in type 2 diabetes exchange cme. Find powerpoint presentations and slides using the power of, find free presentations research about sglt2 2016 ppt. Sglt2 inhibitors have been approved for use as a treatment for diabetes since 20. Comparative effectiveness of sodiumglucose cotransporter. Sglt2 inhibitors reduces glucose sugar levels in your body by increasing the amount of sugar you pass in your urine canagliflozin invokana, dapagliflozin forxiga, empagliflozin jardiance canagliflozin 100 mg may be increasedto 300 mg your dose may depend on. Effects of dapagliflozin, an sglt2 inhibitor, on hba1c, body weight, and hypoglycemia risk in patients with type 2 diabetes inadequately controlled on pioglitazone monotherapy.
Dapagliflozin is a selective reversible inhibitor of sglt2 in the kidney, and the first of this novel class of glucoselowering agents to be made available in australia. Currently, sglt2 inhibitors are not indicated to treat people with t1dm. Safety and efficiency of sglt2 inhibitor combining with. Sodiumglucose cotransporter 2 inhibition and glycemic control in. This report covers a detailed study of the diabetes drugs market size, growth, and share, trends.
Presentation given during the east by southwest, annual update in nephrology, september 17th 2017, santa fe, nm. Sglt2 inhibitors and mechanisms of cardiovascular benefit. Its sglt1 inhibitor function delays glucose from being absorbed by the intestines, while its sglt 2 inhibitor function helps further lower blood glucose level by making the kidney excrete excess glucose. Objective to assess the clinical effectiveness and safety of the sglt2 receptor inhibitors in dual or triple therapy in type 2 diabetes. View sglt 2 inhibitors ppts online, safely and virusfree. Endocrine society reading room the sglt2 inhibitor.
Renub research report titled diabetes drug market, oral dpp. Sodiumglucose cotransporter 2 sglt2 inhibitors are an attractive novel therapeutic option for the treatment of type 2 diabetes. New guidance from the american college of cardiology recommends the use of sodiumglucose cotransporter 2 sglt2 inhibitors and glucagonlike peptide1 receptor agonists glp1ras in patients with type 2 diabetes and established clinical atherosclerotic cardiovascular disease to lower their cv risk. There are several different tablets in the sglt2 group. Invokana, farxiga, and jardiance are example of sglt2 inhibitors approved for use in the us. As required by the regulatory authorities, patients with type 2 diabetes recruited to these trials were randomly assigned to receive either the sglt2 inhibitor in question or placebo and were followed up for cv endpoints. Unlike other agents, sglt2 inhibitors act on the kidney to promote urinary glucose excretion. Four sglt2 inhibitors canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin have been. Sglt2 inhibitors, a new approach in diabetes treatment. Sglt2 inhibition in diabetic kidney disease christos argyropoulos md, ms, phd, fasn assistant professor university of new mexico department of internal medicine division of nephrology 2. Sodiumglucose cotransporter2 sglt2 inhibitors are a new group of oral medications used for treating type 2 diabetes the drugs work by helping the kidneys to lower blood glucose levels. Diabetic kidney disease dkd is now the principal cause of chronic kidney disease leading to endstage kidney disease worldwide. Remove this presentation flag as inappropriate i dont like this i like this remember as a favorite.
It is possible that the sglt2 receptor inhibitors might be particularly useful in patients with longer duration in whom other agents such as the. How do sglt2 inhibitors work to control blood sugar in patients with type 2 diabetes, briefly if you would. Diabetes management can be challenging, often requiring multiple therapeutic agents as the disease progresses. Sodiumglucose linked transporter 2 sglt2 inhibitors such as.
Sglt2 inhibitors is a prescription drug class used to treat people with type 2 diabetes. Rieg and vallon begin the series by tracing the development of the sglt inhibitor class of drugs, including sglt1 inhibitors, sglt2 inhibitors. Cardiac and renal effects of sodiumglucose cotransporter. The actions of sglt2 inhibitors on metabolism, renal function and blood pressure. Sglt2 is more abundantly expressed in proximal tubular epithelial cells in patients with type 2 diabetes mellitus dm than in healthy individuals, leading to excessive glucose reabsorption. Discontinue sglt2 inhibitors in the presence of active foot ulcer, infection. Sglt1 enables the small intestine to absorb glucose and contributes to the reabsorption of glucose filtered by the kidney. Do treatments for heart failure work as well in patients. Fda warns that sglt2 inhibitors for diabetes may result in a. View and download powerpoint presentations on sglt2 inhibitors ppt. The first in class empareg outcome trial, which was designed according to the 2008 us fda regulations to assess cardiovascular safety and not benefit, compared two doses of empagliflozin 10 and 25 mgd with placebo on cardiovascular events in 7020 patients with t2d, established cvd, and egfr30 mlmin per 1. Increased reabsorption of glucose by sglt2 in the proximal convoluted tubule decreases delivery of solutes to the macula densa.
Practice pearls for sglt2 inhibitors activity overview this activity will focus on current issues related to the use of sglt2 inhibitors in patients with diabetes. The selectivity of dapagliflozin for sglt2 is 1 0003 000fold greater than that for sglt1. Fda warns that sglt2 inhibitors for diabetes may result in. Treatments for diabetes may increase or decrease the risk of developing heart failure incident. While the glucose may be falling even into normal ranges, the patient is likely becoming insulinopenic leading to muscle and fat metabolism and ketosis. Until relatively recently, demonstrations of the combination of glucose lowering and safety were the primary. In this subset of their series, the role of the kidneys is examined and the effects of sglt2 inhibitors is explained.
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