Abstract
Recent trials have reported sodium-glucose cotransporter 2 (SGLT2) inhibitors to decrease cardiac morbidity and hospitalization in diabetic patients. They have a remarkable ability to modify the cardiorenal axis and have a safer metabolic profile among the existing pharmacotherapy in diabetes. There are multiple proposed mechanisms postulated behind the cardioprotection offered by these drugs as seen in Canagliflozin Cardiovascular Assessment Study (CANVAS) and Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) Trial. The pathophysiological evidence which directly contributes to improve cardiac mechanics remains elusive. We aimed to review all mechanisms hypothesized and present results from recent trials with new therapies. There is also evidence for a reduction in insulin resistance, inflammation, body weight and serum triglyceride levels which all contribute to improving cardiovascular outcomes in diabetes. However, evidence of adverse effects on bone metabolism and increased risk of genital and urinary tract infections limits their current use. Nonetheless, SGLT2 inhibitors with their cardioprotective effects may serve as a promising advancement in type 2 diabetes management.
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