Abstract
Type 2 diabetes mellitus (T2DM) is a cardio-renal-metabolic condition that is frequently associated with multiple comorbidities, including atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD). The sodium-glucose co-transporter-2 (SGLT2) inhibitors, which lower glycated hemoglobin, fasting and postprandial plasma glucose levels, body weight, and blood pressure, as well as reduce the risk of a range of cardiovascular and renal outcomes without increasing hypoglycaemic risk, have heralded a paradigm shift in the management of T2DM. These drugs are compatible with most other glucose-lowering agents and can be used in patients with a wide range of comorbid conditions, including ASCVD, HF, and CKD, and in those with estimated glomerular filtration rates as low as 30mL/min/1.73m2. However, there are misunderstandings surrounding the clinical implications of SGLT2 inhibitors' mechanism of action and concerns about the key adverse events with which this class of drugs has been associated. This narrative review summarizes the data that support the efficacy of SGLT2 inhibitors in reducing the risks of cardiovascular and renal outcomes in patients with T2DM and comorbid conditions and clarifies information relating to SGLT2 inhibitor-related adverse events.
Highlights
Type 2 diabetes mellitus (T2DM) is a cardiorenal-metabolic condition that is frequently associated with multiple comorbidities, including atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD)
There are misunderstandings surrounding the clinical implications of sodium-glucose cotransporter-2 (SGLT2) inhibitors’ mechanism of action and concerns about the key adverse events with which this class of drugs has been associated. This narrative review summarizes the data that support the efficacy of SGLT2 inhibitors in reducing the risks of cardiovascular and renal outcomes in patients with T2DM and comorbid conditions and clarifies information relating to SGLT2 inhibitor-related adverse events
Neuen et al.[15] found significant reductions vs placebo in the risks of a composite of renal dialysis, transplantation or death due to renal disease (33% reduction in risk), a composite of substantial loss of kidney function, end-stage renal disease (ESRD) or death due to renal disease (42%), acute kidney injury (25%), and ESRD (35%). The importance of this beneficial effect is emphasized by the fact that this reduction in ESRD risk is greater than that achieved with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs),[18] drug classes that are currently recommended for ESRD risk reduction in patients with T2DM, hypertension, and CKD.[11]
Summary
Type 2 diabetes mellitus (T2DM) is a cardiorenal-metabolic condition that is frequently associated with multiple comorbidities, including atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD).
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