A New Class of Oral Medications

Drugs known as sodium-glucose co-transporter-2 inhibitors, or SGLT2 inhibitors, are a new class of oral medications that are used for treating patients with type 2 diabetes. These medications have been approved since 2013, and they are to be taken once a day to help the kidneys lower glucose levels in the blood. Their use has been associated with improved glycemic control, weight loss, and lowering the risk of hypoglycemia.

How SGLT2 Inhibitors Work

Medications within the class of SGLT2 inhibitors work by inhibiting sodium-glucose transport proteins (SGLT2), which are responsible for reabsorbing glucose in the blood. This prevents glucose reabsorption by the kidney, which in turn lowers blood glucose levels. When less glucose is reabsorbed back into the blood, the excess can easily be eliminated from the body by passing through as urine.

Types of SGLT2 Inhibitors

Currently there are three SGLT2 inhibitors available for the treatment of diabetes: empagliflozin, canagliflozin, and dapagliflozin. Empagliflozin is the newest member of the group, having only been approved by the FDA to help treat adult patients battling type 2 diabetes in August 2014. Another drug known as ipragliflozin works as an SGLT2 inhibitor, but it has yet to receive approval for use in the United States.

Diabetic patients, who take SGLT2 inhibitors, should be prepared to make other lifestyle changes in addition to taking medications to control their diabetes. It is recommended that all of these treatment options be used in addition to exercise and diet as a way to improve glycemic control in type 2 diabetes treatment. SGLT2 inhibitors can be used in combination with other treatment options or as a stand-alone therapy.

Benefits of SGLT2 Inhibitors

There are several benefits of SGLT2 inhibitors that have doctors prescribing this treatment method to their patients. The primary benefit is that these inhibitors can reduce the body’s levels of A1C, or glycated hemoglobin. This means that this class of drugs can be especially beneficial for patients who aren’t able to take metformin, which is often the primary drug that is prescribed for treating type 2 diabetes.

SGLT2 inhibitors also offer profound weight loss benefits, which can be beneficial for improving the overall health of diabetes patients. According to researchers from the University of California, San Diego, if a patient who needs to lose weight can maintain a diet of 1500-2000 calories per day, and around 300 calories from glucose pass through the urine, weight loss can occur rapidly. However, some indications suggest that the weight loss effect could bottom out, as, after some period of time, patients may experience an increase in appetite and begin eating more.

Side Effects of SGLT2 Inhibitors

Like all medications, taking SGLT2 inhibitors to control your diabetes could result in some side effects. These drugs result in the excretion of more glucose in the urine, which will increase your chance of contracting urinary tract or genital infections. These side effects occur more frequently in women than in men. Patients who take insulin along with SGLT2 inhibitors also need to be aware of the signs and symptoms of hypoglycemia.

The long-term side effects associated with taking SGLT2 inhibitors aren’t fully understood. Some clinical trials examining dapagliflozin have shown an increased incidence of breast cancer, bladder cancer, and liver cancer among people who take this drug, but the results aren’t clear enough to indicate that there is a distinctive risk. Trials examining the effects of canagliflozin have shown increases in HDL and LDL cholesterol.

It is also important to note that SGLT2 inhibitors are approved for the treatment of type 2 diabetes, and while some of these medications can be used as an add-on therapy for type 1 diabetes treatment, this is not the case with all options. Specifically, the FDA warns that the SGLT2 inhibitor empagliflozin shouldn’t be used for patients with type 1 diabetes. Additionally, patients with severe renal impairment, end-stage renal failure, and diabetic ketoacidosis should also avoid this medication.