What Have We Learned so Far From the Use of Sodium-Glucose Cotransporter 2 Inhibitors in Clinical Practice?

2021 ◽  
Vol 28 (4) ◽  
pp. 290-297
Author(s):  
Peter Rossing ◽  
Frederik Persson
Keyword(s):  
Clinical Practice ◽  
Sodium Glucose Cotransporter

Sodium-glucose Cotransporter 2 Inhibitors and the Risk of Diabetic Ketoacidosis; from Pathophysiology to Clinical Practice

2018 ◽  
Vol 18 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Dimitrios Patoulias ◽  
Alexandros Manafis ◽  
Christos Mitas ◽  
Konstantinos Avranas ◽  
Georgios Lales ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Diabetic Ketoacidosis ◽  
Sodium Glucose Cotransporter

scholarly journals Diabetes Drugs and Cardiovascular Event Reduction: A Paradigm Shift

2018 ◽  
Vol 12 (1) ◽  
pp. 46-50
Author(s):  
Erik M Kelly ◽  
Donald E Cutlip
Keyword(s):  
Clinical Practice ◽  
Cost Effectiveness ◽  
Paradigm Shift ◽  
Cardiovascular Events ◽  
Outcome Data ◽  
Review Article ◽  
Sodium Glucose Cotransporter ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Effectiveness Data

This review article summarizes the recent cardiovascular outcome data for sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide-1 analogues, which have been found to reduce cardiovascular events. We also detail the implications these new medications will have on clinical practice through a review of recent diabetes guidelines and cost-effectiveness data.

scholarly journals Emerging glucose-lowering therapies: a guide for cardiologists

Heart ◽  
2019 ◽  
Vol 106 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Gaurav S Gulsin ◽  
Matthew P M Graham-Brown ◽  
Melanie J Davies ◽  
Gerry P McCann
Keyword(s):  
Cardiovascular Disease ◽  
Clinical Practice ◽  
Large Scale ◽  
Cardiovascular Outcome ◽  
Glucose Lowering ◽  
Cardiovascular Outcome Trials ◽  
Sodium Glucose Cotransporter ◽  
Emerging Treatments ◽  
Glucagon Like Peptide 1 ◽  
Safety Considerations

In recent large-scale cardiovascular outcome trials, two new classes of glucose-lowering medications—sodium glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs)—demonstrated cardiovascular benefits in adults with type 2 diabetes mellitus (T2DM). These findings have prompted growing optimism among clinicians regarding the potential for these agents to reduce the burden of cardiovascular disease in people with T2DM. GLP-1RAs and SGLT2i are now advocated as second-line agents in European and US guidelines for management of both hyperglycaemia and for primary prevention of cardiovascular disease in people with T2DM. Given the high prevalence of T2DM in patients with cardiovascular disease, cardiologists will increasingly encounter these agents in routine clinical practice. In this review, we summarise evidence from cardiovascular outcome trials of GLP-1RAs and SGLT2i, give practical advice on prescribing and detail safety considerations associated with their use. We also highlight areas where further work is needed, giving details on active clinical trials. The review aims to familiarise cardiologists with these emerging treatments, which will be increasingly encountered in clinical practice, given the expanding representation of T2DM in patients with cardiovascular disease. Whether these drugs will be initiated by cardiologists remains to be determined.

scholarly journals Sodium-Glucose Cotransporter-2 Inhibitors in Nephrology Practice: A Narrative Review

2020 ◽  
Vol 7 ◽  
pp. 205435812093570
Author(s):  
Lisa Dubrofsky ◽  
Anand Srivastava ◽  
David Z. Cherney
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Primary Care Physicians ◽  
Real Life ◽  
Atherosclerotic Cardiovascular Disease ◽  
Specific Patient ◽  
Sodium Glucose Cotransporter

Purpose of the review: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended for eligible patients with type 2 diabetes for the secondary prevention of adverse cardiovascular and kidney disease outcomes. Patients with type 2 diabetes and albuminuric chronic kidney disease, a history of atherosclerotic cardiovascular disease, and/or heart failure with reduced ejection fraction should be assessed for the use of these therapies. Sources of information: The sources include published clinical trials with SGLT2is, with a focus on cardiovascular safety studies and kidney protection trials. Methods: Information was gathered via a review of relevant literature and clinical practice guidelines, incorporated with real-life clinical experience. Key findings: Clinicians prescribing these agents must be familiar with the benefits of SGLT2is on cardiovascular and renal endpoints, and with adverse effects of SGLT2is, including mycotic genital infections and diabetic ketoacidosis. Primary care physicians and specialists should know how to adjust antihypertensive, antiglycemic, and diuretic agents. With the results of completed cardiovascular outcome trials and the Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy trial, nephrologists specifically have a unique opportunity to impact the safe, effective, and equitable implementation of SGLT2is into clinical practice. Limitations: Further work is needed in specific patient subgroups, including patients with chronic kidney disease stages IV and V, patients with kidney disease but lower levels of albuminuria, and in patients without diabetes.

Finerenone: A Novel Mineralocorticoid Receptor Antagonist for Cardiorenal Protection in CKD and T2DM

2022 ◽  
pp. 106002802110595
Author(s):  
Allissa Long ◽  
Marissa Salvo
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Safety Information ◽  
Mineralocorticoid Receptor Antagonist ◽  
Sodium Glucose Cotransporter

Objective: To describe the pharmacology, clinical and safety evidence, and relevance to clinical practice of finerenone. Data Sources: A literature search was conducted utilizing PubMed, MEDLINE, and clinicaltrials.gov with search terms of “finerenone” and “BAY94-8862.” Study Selection and Data Extraction All available studies with human participants in English were considered. Studies were included if they investigated drug pharmacology, efficacy, and safety information. Data Synthesis In addition to standard of care with a renin-angiotensin system inhibitor (RASi), finerenone lowered the risk of kidney disease progression (17.8% vs 21.1%) in patients with type 2 diabetes mellitus and chronic kidney disease compared to placebo. Similarly, finerenone reduced cardiovascular risk in patients with type 2 diabetes mellitus and chronic kidney disease compared to placebo (12.4% vs 14.2%). Relevance to Patient Care and Clinical Practice It is anticipated that finerenone will be added to therapy after a RASi and a sodium-glucose cotransporter-2 inhibitor, as tolerated, based on adverse events and potassium levels. Conclusions Finerenone offers a unique approach to further delay the progression of chronic kidney disease in patients with type 2 diabetes mellitus. It also provides another option for patients who cannot tolerate RASi or sodium-glucose cotransporter-2 inhibitors.

scholarly journals Application of 2021 American Diabetes Association Glycemic Treatment Clinical Practice Recommendations in Primary Care

2021 ◽  
Author(s):  
Caitlin Colling ◽  
Steven J. Atlas ◽  
Deborah J. Wexler
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Atherosclerotic Cardiovascular Disease ◽  
Agent Based ◽  
Practice Recommendations ◽  
Sodium Glucose Cotransporter ◽  
Patients With Diabetes ◽  
Primary Care Patients ◽  
Glucagon Like Peptide 1 ◽  
Design And Methods

<b>Objective</b> <p>We aimed to identify the proportion of primary care patients meeting criteria for sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) for cardiorenal comorbidities per 2021 ADA Clinical Practice Recommendations using readily available electronic health record (EHR) characteristics.</p> <p> </p> <p><b>Research Design and Methods</b></p> <p>We applied 2021 ADA recommendations to a primary care cohort of 13,350 adults with type 2 diabetes (T2D).</p> <p> </p> <p><b>Results</b></p> <p>Thirty-three percent of patients with diabetes would be eligible for an SGLT2i or GLP-1 RA based on cardiorenal comorbidities. Thirteen percent of patients meet criteria for SGLT2i based on heart failure or albuminuric chronic kidney disease (CKD); 18% of patients met criteria for either agent based on atherosclerotic cardiovascular disease or CKD with UACR≤300 mg/g. </p> <p> </p> <p><b>Conclusions</b></p> <p>This EHR algorithm identified one-third of primary care T2D patients as meeting criteria for SGLT2i and GLP-1 RA based on strict comorbidity definitions according to 2021 ADA recommendations. </p>

scholarly journals Sodium-glucose Cotransporter 2 Inhibitors and Anemia Among Diabetic Patients in Real Clinical Practice: a Retrospective Observational Study.

2021 ◽  
Author(s):  
Miho Murashima ◽  
Tomohiro Tanaka ◽  
Atsuki Ide ◽  
Minamo Tomohiro Ono ◽  
Masashi Mizuno ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Case Control Study ◽  
Case Control ◽  
Lower Prevalence ◽  
Cross Sectional ◽  
Sodium Glucose Cotransporter ◽  
The Cross ◽  
Control Study ◽  
Prevalence Of Anemia ◽  
Real Clinical Practice

Abstract Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) were reported to increase hemoglobin levels in short-term clinical trials. Whether it is also true in real clinical practice is unknown. Methods: This is a retrospective cohort study. Inclusion criterion was diabetics who visited our outpatient clinic from January 2019 to August 2020. Exposure of interest was the use of SGLT2i. Outcomes were hemoglobin levels. For the cross-sectional analyses, non-linear regression models were fitted with restricted cubic splines to investigate the association between hemoglobin levels and estimated glomerular filtration rate (eGFR) for users and non-users of SGLT2i. For the case-control study, cases (anemia defined as hemoglobin <120 g/L for men, <110 g/L for women or the use of erythropoiesis stimulating agents) and controls were matched by age, sex, and eGFR. Results: Among 2063 diabetics, 723 were on SGLT2i. In the cross-sectional analyses, hemoglobin levels were higher among SGLT2i users compared with non-users at eGFR >15 mL/min/1.73m2. For the case-control study, 197 cases and controls were matched. Conditional logistic regression showed that the use of SGLT2i was associated with significantly lower prevalence of anemia (OR: 0.35 [0.21-0.58]). Adjusted mean differences (95% CIs) in hemoglobin levels between users and propensity score-matched non-users of SGLT2i were 7.0 (3.0-10.0) g/L at 6 months. Among SGLT2i users, odds of increase in 6-month hemoglobin were similar across eGFR categories except for eGFR <15 mL/min/1.73m2.Conclusions: The use of SGLT2i was associated with higher hemoglobin levels and lower prevalence of anemia in real clinical practice.

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