SGLT2-inhibitors – antihyperglycaemic agents with benefits beyond glucose control
Bajcsy-Zsilinszky Kórház és Rendelőintézet, Budapest
SGLT2 (sodium-glucose co-transporter)-inhibitors were developed for treating patients with type 2 diabetes. Efficacy and safety of these drugs were documented in several phase 3 clinical trials. The position of SGLT2-inhibitors in the therapeutic approach for patients with type 2 diabetes were assigned in different guidelines and use of these drugs were suggested in dual or triple combination therapy after failure with metformin-monotherapy. According to requirements of health authorities, cardiovascular safety trials were conducted and completed with four drugs (empagliflozin, dapagliflozin, canagliflozin, ertugliflozin). Unexpectedly, not only safety but marked cardiovascular and renal benefits were published in 2015 after completing the trial with empagliflozin (vs. placebo) in patients with type 2 diabetes and very high cardiovascular risk.
In addition, data available from several cardiovascular trials with SGLT2-inhibitors in the past five years resulted in up-dated publications of guidelines regarding antihyperglycaemic treatment of patients with type 2 diabetes. Recently, cardiovascular risk categories, presence or absence of heart failure and chronic kidney disease should be evaluated and considered first at modification of pharmacological treatment. Although SGLT2-inhibitors were introduced in diabetology several years ago, it became apparent by now that these antihyperglycaemic agents have potentials beyond glucose control. Accordingly, we experience a slow but continuous revolution of an anti-diabetic drug in cardiology and nephrology.