Medicine & USMLE

SGLT2 Inhibitors

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Diabetes Drugs (New)
  1. DPP-4 Inhibitors
  2. GLP-1 Analogs
  3. Pramlintide (Amylin Analogs)
  4. SGLT2 Inhibitors
  5. Metformin (Biguanides)

Summary

SGLT2 Inhibitors, short for sodium-glucose co-transporter 2 inhibitors, are a class of drugs with names that end in -gliflozin, such as canagliflozin, empagliflozin, and dapagliflozin. These drugs are used to lower blood sugar levels in order to treat type 2 diabetes mellitus. By inhibiting the SGLT2 cotransporters, these drugs decrease the reabsorption of glucose in the kidneys, especially in the proximal convoluted tubules of the kidney. Decreased reabsorption of glucose in the kidney causes glycosuria, or increased sugar levels in the urine.

Side effects of taking the SGLT2 inhibitors include an increased risk of developing urinary tract infections, as well as dehydration. These drugs are also known to cause weight loss in patients. The SGLT2 inhibitors are also associated with an increased risk of vaginal candidiasis. Since these drugs require some kidney function in order to work, they should be used with caution in patients with renal insufficiency. Lastly, these drugs typically do not cause hypoglycemia.

Key Points

  • Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors
    • Drug Names
      • -gliflozins
        • Canagliflozin
        • Dapagliflozin
        • Empagliflozin
    • Mechanism
      • Blocks reabsorption of glucose from urine
        • SGLT-2 is a co-transporter in the proximal convoluted tubule of the kidneys, responsible for reabsorbing ~90% of sugar excreted into the renal filtrate
        • Leads to glycosuria
      • Use with caution in patients with renal insufficiency
        • Decreased efficacy with reduced GFR
        • Since drug relies on renal function to work
    • Clinical Use
      • Treats diabetes mellitus
        • Second-line therapy typically added to oral agents to improve glycemic control
    • Side Effects
      • UTIs
        • Increasing sugar in the urine predisposes to infection
      • Vulvovaginal Candidiasis
        • Increasing sugar in the urine predisposes to infection
      • Dehydration (orthostatic hypotension)
        • Glucose excretion also increases water loss via osmotic forces
      • Weight loss
        • May be desirable in some patients
      • Does Not Cause Hypoglycemia
        • These drugs do not modulate insulin levels