Role of sodium-glucose linked co-transporter (SGLT2) in the role of Type 2 Diabetes Mellitus
Source: My personal notes from “The Right Patients, the Right Fit” drugs education session with Ronald Goldenbury, Endocrinology
T2DM treatment + options, drugs, impact
Care options
Section titled “Care options”- No hypoglycemia
- A1C target
- Weight loss
- Insulin independence
- Blood pressure target
- Easy treatment in drugs
- Recommendations: lifestyle, weight loss, pharmacotherapy
Initial pharmacotherapy due to higher A1C > metformin
Enhance insulin through:
- Drugs
- glucose loss = SGLT2 inhibition
- reduce glucose intake
Side effects: weight gain, tolerance, hypoglycemia, A1C impact
About SGLT2 Inhibitors
Section titled “About SGLT2 Inhibitors”- Consider metformin therapy
- Specific risks
- Renal function - an active kidney is required. Renal impairment will reduce use
Inhibitors block glucose reabsorption, resulting in glucose excreted in urine. “You pee out glucose” and calorie reduction. Works best when A1C is very high. High plasma glucose = more glucose loss.
Weight loss - good tolerance : )
Good Effects
Section titled “Good Effects”- Weight loss
- Lower blood glucose
- Lower blood pressure
Adverse Effects
Section titled “Adverse Effects”- Genital mycotic infections (due to glucose in urine)
- Urinary track infection (UTI)
- Osmotic related - increase urine output - frequency and volume
- Volume related
- Increase water loss
- Watch for patients who already are low on fluid
- Caution on age, loop diuretics, poor renal efficiency (see patient eGFR Glomular filtration relate), ACE + ARB issues
- Hypoglycemia (rare)
Other Considerations
Section titled “Other Considerations”LDL cholestrol, cardio, K+ concentration