Chapter 13 - Sodium-glucose Co-transporter-2 inhibitors: a new era of cardioprotection and renoprotection

Abstract

Sodium glucose cotransporter-2 (SGLT2) inhibitors are a novel class of glucose-lowering medications that reduce HbA1c by induction of glucosuria. Several studies have shown that SGLT2 inhibitors are associated with favorable effects on cardiovascular risk factors, including blood pressure, body weight, and lipid profile. More importantly, subsequent large cardiovascular outcome trials have demonstrated significant cardiac and renal benefits with the use of SGLT2 inhibitors in patients with type 2 diabetes, as well as in those with heart failure and/or chronic kidney disease—irrespective of diabetes status. Due to their cardiorenal benefits, SGLT2 inhibitors have become a cornerstone for the management of type 2 diabetes in patients with established cardiovascular disease and CKD. This chapter aims to provide a comprehensive overview of the mechanism of action, cardiac, and renal protective benefits and safety of SGLT2 inhibitors, based on randomized controlled trials, meta-analyses, and real-world data. We finally briefly review the changes in clinical practice guidelines now recommending the use of SGLT2 inhibitors in specific groups of patients, based on an expanding evidence base in diabetes and beyond.