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Positioning SGLT2 Inhibitors in Diabetes Treatment Algorithm

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Dr Ambrish Mithal    24 November 2018

  1. According to the AACE 2018 guidelines, SGLT2i are recommended over other AHAs.
  2. According to the ADA/EASD 2018 consensus statement, SGLT2i are the preferred OHAs in T2DM patients with ASCVD and CKD. SGLT2i are the choice after metformin to minimize weight gain or promote weight loss. They are also the OAD of choice after metformin to minimize hypoglycemia.
  3. T2DM patients present with several risk factors for CVD, including hyperglycemia, hypertension, obesity and albuminuria.
  4. In the results from the CANVAS Program, the composite outcome of sustained doubling of serum creatinine, end-stage kidney disease, and death from renal causes occurred less frequently in the canagliflozin group compared with the placebo group.
  5. About 50% of diabetics develop HF in their lifetime. SGLT2i are promising agents in T2DM patients with HF.
  6. Novel mechanisms include: Fuel shift; NHE-mediated effects; interstitial volume; cardiac remodeling; heme oxygenase (HO-1) and increased hematocrit.
  7. The US FDA suggests that canagliflozin can be used to reduce the risk of MACE in adults with T2DM and established CVD.

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