SGLT2 Inhibitors: 4 Questions Go Back to Basics
The SGLT-2 inhibitor class, originally approved as antihyperglycemic agents for T2D, has proven "pluripotent," adding indications for related conditions. Test your knowledge of a few basic facts.
The sodium glucose contransporter-2 inhibitors (SGLT2is) are a relatively new class of medications, less than 10-years-old; the first approval was for canagliflozin (Invokana) in 2013. Since then, they’ve become a mainstay of treatment for patients with type 2 diabetes (T2D) including addition to professional society treatment algorithms; the SGLT2is also have demonstrated significant benefit in other health conditions in patients with and without T2D.
How much do you know about this important class of medications? Find out with these 4 questions.
1. Which of the above are FDA-approved indications for SGLT2is?
Answer: D. All the above. The SGLT2 inhibitors were initially approved only for glycemic control of T2D. Since then, however, the indications have been expanded to reduce the risk of cardiovascular death, major cardiovascular events, and end-stage kidney disease in patients with T2D, and most recently to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with heart failure and reduced ejection fraction, regardless of diabetes status.
2. What are the potential adverse effects of SGLT2i?
Answer: D. All the above. Although SGLT2i do modestly increase LDL, they do not increase the risk of CV events. As previously discussed, several SGLT2i have been shown to reduce the risk of CV events in certain patients. Genitourinary tract infections are one of the most common adverse effects but can be treated and should not generally be a reason to discontinue the medication. Fournier’s gangrene has been rarely reported: from March 2013 to May 2018, the FDA identified 12 cases of Fournier’s gangrene in patients taking SGLT2i.
3. By about how much can SGLT2i be expected to lower A1c?
Answer: A. 0.5% - 0.8%. While SGLT2i do lower A1c less than some other classes of medications, their cardiovascular and mortality benefits make them a good choice for many patients with Type 2 Diabetes. For more information on choosing an agent for the management of T2D, take a look at the latest ADA Guidelines (2021).
4. Which of the following are advantages of SGLT2i when used to treat T2D?
Answer: A and B. SGLT2i are a great choice not only for their cardiovascular and mortality benefits, but also because they carry a minimal risk of hypoglycemia. While they only result in modest weight loss, they do not cause weight gain, giving them another advantage. For many patients, seeing even a little progress in losing weight can be a real motivator and help them get on track to a healthier lifestyle, so this benefit should not be underestimated. Patient assistance programs can help eligible patients afford these medications:
•Invokana: Johnson and Johnson Patient Assistance Foundation
•Farxiga: AZandM
•Jardiance: BI Cares
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