A new class of drugs could dramatically improve Type 2 diabetes treatment by spurring diabetics to excrete excess sugar through their urine.
What’s more, the drugs, called SGLT2 inhibitors, boost overall health by promoting weight loss.
A reduced level of blood sugar is a major treatment goal in Type 2 diabetes, which affects an estimated 26 million Americans.
The disease can lead to serious complications such as heart and kidney disease, nerve damage, amputations, blindness, and premature death.
The FDA has green-lighted three SGLT2 inhibitors:
Canagliflozin (Invokana), approved March, 2013
Dapagliflozin (Farxiga), approved January, 2014
Empagliflozin (Jardiance), approved August, 2014
Most diabetes drugs target the liver, pancreas, or gut to improve insulin sensitivity, reduce insulin resistance, or stimulate insulin secretion.
But SGLT2 inhibitors work in a different way. They have no effect on insulin. Instead, they target the kidneys to block the reabsorption of sugar, increase sugar excretion, thereby reducing blood sugar levels.
They work by inhibiting a substance called SGLT2, sodium-glucose co-transporter 2.
“This transporter is responsible for reabsorbing the majority of glucose filtered by the kidneys,” says Jean-Marc Guettier, M.D., director of the CDC’s Division of Metabolism and Endocrinology Products.
The most recently approved SGLT2 inhibitor — Jardiance — was evaluated in seven clinical trials which included 4,480 participants.
Compared to a placebo, Jardiance significantly improved hemoglobin A1c levels, an important measure of blood-sugar control.
Experts say that SGLT2 inhibitors are most likely to benefit obese patients who have normal kidney function.
In such patients, an SGLT2 inhibitor often is just as effective at lowering blood sugar as better-known diabetes drugs such as metformin, sulfonylureas, pioglitazone, or insulin.
The FDA has approved SGLT2 inhibitors for use as stand-alone drugs or in combination with other diabetes drugs.
“Type 2 diabetes is a progressive disease and patients often require multiple antidiabetic agents to control glucose as disease progresses,” Dr. Guettier tells Newsmax Health.
SGLT2 inhibitors are best for patients with normal kidney function. But they’re not as well-tolerated in patients who have moderate kidney disease.
They’re not recommended for patients who have severe kidney impairment, end-stage renal disease, or are on dialysis.
“Such subjects don’t benefit from SGLT2 inhibitors and shouldn’t be prescribed them,” says Dr. Guettier.
Other groups who should avoid SGLT2 inhibitors include pregnant women, children, those with Type 1 diabetes, patients with diabetic ketoacidosis, which increases the level of ketones in blood or urine.
In patients with normal kidney function, SGLT2 inhibitors are associated with a welcome side effect: weight loss.
Studies show that the drugs are associated with a body weight loss of 2.8 percent to 5.7 percent, which could significantly improve overall health.
Most other diabetes drugs either have no effect on weight or can actually cause weight gain. The only exception is metformin, which also is associated with modest weight loss.
SGLT2 inhibitors have a mild diuretic effect because they tend to increase urination.
In patients with hypertension, this effect may result in a beneficial lowering of blood pressure. In other patients, however, it may cause lightheadedness, dizziness, or fainting.
The most common adverse side effects associated with SGLT2 inhibitors are genital yeast infections, urinary tract infections, dehydration, and modestly increased levels of LDL (“bad”) cholesterol.
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