What is the role of SGLT2 inhibitors in diabetes management, particularly in Indian patients?

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a novel class of drugs for the treatment of type 2 diabetes that act by increasing urinary glucose excretion. These agents are efficacious as monotherapy and add-on therapy for patients with type 2 diabetes. The available SGLT2 inhibitors have a rapid oral absorption, a long elimination half-life facilitating once daily administration, extensive hepatic metabolism, absence of clinically relevant drug-drug interactions and a low renal elimination as parent drug.

Several Indian studies have shown SGLT2 inhibitors, particularly canagliflozin, to yield good glycemic control, body weight reduction, and good tolerability in patients with T2DM, similar to that seen in patients across the globe. Modest reductions in blood pressure have been noted with SGLT2 inhibitor therapy. The American Diabetes Association and the European Association for the Study of Diabetes recommend the use of SGLT2 inhibitors as one of the second-line therapy.

Where does canagliflozin stand in the diabetes therapeutic armamentarium?

The CANVAS Program met its primary objective of demonstrating the cardiovascular (CV) safety and efficacy of canagliflozin. Data suggest a favorable benefit-risk profile with canagliflozin in many patients with type 2 diabetes and high CV risk. Data from the CANVAS Program suggests that canagliflozin had a renal benefit in patients with type 2 diabetes who were at high risk for cardiovascular events. Canagliflozin treatment is associated with a reduced risk of sustained loss of kidney function, attenuated eGFR decline, and a reduction in albuminuria, thus pointing to a possible renoprotective effect of this drug in people with type 2 diabetes. A recent study has also shown that canagliflozin could improve left ventricular diastolic function within 3 months in patients with T2DM. Apart from CANVAS, data from Credence has shown that in patients with eGFR upto 30 add on treatment with Canagliflozin to standard of care with ACE? ARB is renoprotectiev,it was the first trail with SGLT-2 inhibitor to show this effect.

Therefore, canagliflozin seems to have a key role in diabetes management.