SGLT2 inhibitors: practical considerations and recommendations for cardiologists

Current Opinion in Cardiology
Erika OpingariHarpreet S Bajaj

Abstract

To address common concerns regarding sodium-glucose cotransporter 2 (SGLT2) inhibitor use for patients with type 2 diabetes mellitus (T2DM) in cardiovascular practice. SGLT2 inhibitors provide glycemic control and improve cardiovascular and renal endpoints in T2DM. Cardiovascular outcome trials have demonstrated sustained cardiovascular, heart failure and renal benefits independent of glycemic control, which persist down to an eGFR of 30 ml/min/1.73 m. SGLT2 inhibitors can be safely administered alongside common diuretics, and routine monitoring of renal function is advised at initiation of therapy, particularly for patients on loop diuretics. Mild initial reductions in eGFR are expected, usually stabilizing over time. The most common adverse effect noted with SGLT2 inhibitors is genital mycotic infections, primarily in women. Less common, but concerning effects associated with canagliflozin include increased risk of fractures and lower limb amputations, particularly in patients with previous amputation history. Overall, SGLT2 inhibitors are well tolerated and effective adjuncts to diabetic treatment, for which the benefits seem to outweigh the risks. The care of patients with T2DM requires an interdisciplinary team approach, w...Continue Reading

References

Sep 18, 2015·The New England Journal of Medicine·Bernard ZinmanUNKNOWN EMPA-REG OUTCOME Investigators
Nov 19, 2015·The Journal of Clinical Endocrinology and Metabolism·Nelson B WattsGary Meininger
Jun 15, 2016·The New England Journal of Medicine·Christoph WannerUNKNOWN EMPA-REG OUTCOME Investigators
Dec 13, 2016·Nature Reviews. Nephrology·Ralph A DeFronzoMuhammad Abdul-Ghani
Apr 26, 2017·Diabetes/metabolism Research and Reviews·Darin RuanpengTasma Harindhanavudhi
Jun 13, 2017·The New England Journal of Medicine·Bruce NealUNKNOWN CANVAS Program Collaborative Group
Jan 13, 2018·Diabetes, Obesity & Metabolism·Itamar RazStephen D Wiviott
Feb 25, 2018·Drugs·Anthony Markham
Apr 14, 2018·Canadian Journal of Diabetes·UNKNOWN Diabetes Canada Clinical Practice Guidelines Expert CommitteeScot Simpson
May 8, 2018·Kidney International·Hiddo J L HeerspinkDavid Z I Cherney

❮ Previous
Next ❯

Citations

Feb 8, 2019·Clinical Nurse Specialist CNS·Patricia Anne O'Malley
Jul 11, 2019·Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders·Amar AliUNKNOWN As part of The Improving Diabetes Steering Committee
Apr 2, 2019·Expert Opinion on Drug Safety·André J Scheen
Jun 3, 2021·Journal of Clinical Medicine·Henri LuRoger Hullin

❮ Previous
Next ❯

Related Concepts

Related Feeds

CV Disorders & Type 2 Diabetes

This feed focuses on the association of cardiovascular diseases in patients with type 2 diabetes.

Cardiovascular Disorder in Diabetes

Diabetes is associated with an increased risk of cardiovascular disorders and heart failure. Discover the latest research here.