EXPLORE!

Medical Voice 8th February 2019

  905 Views

Dr KK Aggarwal    08 February 2019

SGLT2 inhibitors in diabetes

  • SGLT2 inhibitors are a class of prescription medicines that are FDA-approved for use with diet and exercise to lower blood sugar in adults with type 2 diabetes.
  • Medicines in the SGLT2 inhibitor class include canagliflozin, dapagliflozin, and empagliflozin.
  • They are available as single-ingredient products and also in combination with other diabetes medicines such as metformin.
  • SGLT2 inhibitors lower blood sugar by causing the kidneys to remove sugar from the body through the urine.
  • These drugs are recommended for consideration for glucose-lowering therapy in patients who have not achieved glucose control with metformin.
  • The drugs are associated with significant reductions in HbA1c levels when compared with placebo, with the greatest reductions seen with canagliflozin 300mg monotherapy.
  • SGLT2 inhibitors are associated with weight loss, largely due to reductions in visceral fat, and that there is a growing body of evidence to suggest they are linked to reductions in serious cardiovascular complications and progression of kidney disease.
  • The drugs are also associated with an increased risk of genital infections, and that they should be used with caution in patients at high risk of lower limb amputations (LLAs).
  • The drugs should also be suspended immediately in patients with acute illness or who have planned surgical procedures, during which the type 2 diabetes sick day rules apply.
  • The treatment plan will differ for each person, but in general SGLT2 inhibitors are taken once a day before the first meal. The typical dose is 100 – 300 mg (canagliflozin), 5-10 mg (dapagliflozin), or 10 – 25 mg (empagliflozin), depending on the patient’s needs. In most cases, SGLT2 inhibitors are used in addition to other diabetes medications.
  • Kidney function needs to be tested before and during treatment with SGLT2 inhibitors
  • Persons with severe kidney disease or on dialysis are not recommended to be on this medicine.

AF a new epidemic of the society

  1. Atrial fibrillation (AF) is the most prevalent cardiac rhythm disorder in the elderly population and is the leading cause of stroke and systemic embolic events.
  2. Doctors may classify it as paroxysmal, persistent, or permanent, the risk for thromboembolism appears to be consistent among these categories.
  3. AF usually originates in the left atrium at the pulmonary veins and can be easily detected and diagnosed on the basis of an irregular pattern with varying RR intervals on ECG.
  4. Patients with AF may be completely asymptomatic, opportunistic screening for silent AF can be easily performed at low cost and is therefore recommended in patients aged > 65 years
  5. AF is usually not life-threatening, but it can elicit serious complications including thromboembolic events.
  6. AF results in a state of hypercoagulation due to stasis and turbulence in the atrial auricles and may trigger the development of clots causing thromboembolic events.
  7. Maintaining sinus rhythm by using electric cardioversion and/or antiarrhythmic drugs does not reduce the risk for stroke
  8. AF is associated with an increased risk for heart failure, ventricular arrhythmias, and death, and it worsens the prognosis of concomitant cardiovascular diseases. However, it remains uncertain whether AF is causally linked to these conditions.
  9. Anticoagulation is superior to that of antiplatelet agents alone.
  10. the CHA2DS2VASc score—a seven-variable score consisting of age, sex, history of heart failure, hypertension, stroke, vascular disease, and diabetes—has replaced and expanded the previously used CHADS2 score.
  11. Oral anticoagulation should be considered in all patients with a score ≥ 2; patients with a score of 0 are at low risk.

To comment on this article,
create a free account.

Sign Up to instantly get access to 10000+ Articles & 1000+ Cases

Already registered?

Login Now

Most Popular Articles

News and Updates

eMediNexus provides latest updates on medical news, medical case studies from India. In-depth medical case studies and research designed for doctors and healthcare professionals.