Gliflozin

SGLT2 inhibitors, also called gliflozins, are a class of medications that inhibit reabsorption of glucose in the kidney and therefore lower blood sugar. They act by inhibiting sodium-glucose transport protein 2 (SGLT2). SGLT2 inhibitors are used in the treatment of type II diabetes mellitus (T2DM). Apart from blood sugar control, gliflozins have been shown to provide significant cardiovascular benefit in T2DM patients. Several medications of this class have been approved or are currently under development.In studies on canagliflozin, a member of this class, the medication was found to enhance blood sugar control as well as reduce body weight and systolic and diastolic blood pressure. SGLT2 inhibitors, also called gliflozins, are a class of medications that inhibit reabsorption of glucose in the kidney and therefore lower blood sugar. They act by inhibiting sodium-glucose transport protein 2 (SGLT2). SGLT2 inhibitors are used in the treatment of type II diabetes mellitus (T2DM). Apart from blood sugar control, gliflozins have been shown to provide significant cardiovascular benefit in T2DM patients. Several medications of this class have been approved or are currently under development.In studies on canagliflozin, a member of this class, the medication was found to enhance blood sugar control as well as reduce body weight and systolic and diastolic blood pressure. The gliflozins are used to treat type 2 diabetes mellitus but are most often used as second- or third-line agents instead of first-line because there are other medications on the market that have much longer safety record and are less expensive than gliflozins. Gliflozins may be a good option for patients who are failing with metformin monotherapy, especially if reducing weight is part of the underlying treatment.They are often used in combination therapy, for example the dual therapy metformin plus gliflozin and the triple therapy metformin, sulfonylurea and gliflozin. A recent systematic review and network meta-analysis (comparing SGLT-2 inhibitors, GLP-1 agonists and DPP-4 inhibitors) demonstrated that use of SGLT2 inhibitors was associated with a 20% reduction in death compared with placebo or no treatment. Genital infections seem to be the most common adverse effect of gliflozins. In clinical trials mycotic infections, urinary tract infections and osmotic diuresis were higher in patients treated with gliflozins. In May 2015 FDA issued a warning that gliflozins can increase risk of diabetic ketoacidosis (DKA). By reducing glucose blood circulation, gliflozins cause less stimulation of endogenous insulin secretion or lower dose of exogenous insulin that results in diabetic ketoacidosis (DKA). They can also contribute euglycemic DKA (euDKA) because of the renal tubular absorption of ketone bodies. In September 2015 FDA issued a warning related to canagliflozin (Invokana) and canagliflozin/metformin (Invokamet) due to decreased bone mineral density and therefore increased risk of bone fractures. Using gliflozins in combination therapy with metformin can lower the risk of hypoglycemia compared to other T2DM such as sulfonylureas and insulin. Increased risk of lower limb amputation is associated with canagliflozin but further data is needed to confirm this risk associated with different gliflozins. In August 2018 the FDA issued a warning of an increased risk of Fournier gangrene in patients using SGLT2 inhibitors.