scholarly journals The EMPEROR-Reduced trial: SGLT2 inhibitors for heart failure get more support

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
Kerolos Wagdy
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mechanism Of Action ◽  
Sglt2 Inhibitors ◽  
New Class ◽  
Glucose Reabsorption ◽  
Unique Mechanism

[no abstract - showing first paragraph]Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a relatively new class of antihyperglycemic medication that are well established for the management of type-2 diabetes mellitus (DM). They have a unique mechanism of action that targets the kidneys through inhibition of 90% of glucose reabsorption.

scholarly journals DAPA-HF trial signals the birth of ‘diabetic cardiology’ and more

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Kerolos Wagdy ◽  
Peter Selwanos
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mechanism Of Action ◽  
Sglt2 Inhibitors ◽  
New Class ◽  
Glucose Reabsorption ◽  
Unique Mechanism

[no abstract - showing first paragraph of article]Sodium-glucose co-transporter-2 (SGLT2) inhibitors are relatively new class of antihyperglycemic medication that is well established in the management of type 2 diabetes mellitus (DM). It has a unique mechanism of action that targets the kidneys through inhibiting 90% of glucose reabsorption.

Mechanisms of Protective Effects of SGLT2 Inhibitors in Cardiovascular Disease and Renal Dysfunction

2019 ◽  
Vol 19 (20) ◽  
pp. 1818-1849 ◽  
Author(s):  
Ban Liu ◽  
Yuliang Wang ◽  
Yangyang Zhang ◽  
Biao Yan
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Renal Dysfunction ◽  
Sglt2 Inhibitors ◽  
Sodium Glucose Cotransporter ◽  
Glucose Reabsorption ◽  
Renal Glucose Reabsorption

: Type 2 diabetes mellitus is one of the most common forms of the disease worldwide. Hyperglycemia and insulin resistance play key roles in type 2 diabetes mellitus. Renal glucose reabsorption is an essential feature in glycaemic control. Kidneys filter 160 g of glucose daily in healthy subjects under euglycaemic conditions. The expanding epidemic of diabetes leads to a prevalence of diabetes-related cardiovascular disorders, in particular, heart failure and renal dysfunction. Cellular glucose uptake is a fundamental process for homeostasis, growth, and metabolism. In humans, three families of glucose transporters have been identified, including the glucose facilitators GLUTs, the sodium-glucose cotransporter SGLTs, and the recently identified SWEETs. Structures of the major isoforms of all three families were studied. Sodium-glucose cotransporter (SGLT2) provides most of the capacity for renal glucose reabsorption in the early proximal tubule. A number of cardiovascular outcome trials in patients with type 2 diabetes have been studied with SGLT2 inhibitors reducing cardiovascular morbidity and mortality. : The current review article summarises these aspects and discusses possible mechanisms with SGLT2 inhibitors in protecting heart failure and renal dysfunction in diabetic patients. Through glucosuria, SGLT2 inhibitors reduce body weight and body fat, and shift substrate utilisation from carbohydrates to lipids and, possibly, ketone bodies. These pleiotropic effects of SGLT2 inhibitors are likely to have contributed to the results of the EMPA-REG OUTCOME trial in which the SGLT2 inhibitor, empagliflozin, slowed down the progression of chronic kidney disease and reduced major adverse cardiovascular events in high-risk individuals with type 2 diabetes. This review discusses the role of SGLT2 in the physiology and pathophysiology of renal glucose reabsorption and outlines the unexpected logic of inhibiting SGLT2 in the diabetic kidney.

scholarly journals Type 2 Diabetes Mellitus and Heart Failure: Innovative Possibilities for Management of Prognosis

Kardiologiia ◽  
2019 ◽  
Vol 59 (4) ◽  
pp. 76-87 ◽  
Author(s):  
Zh. D. Kobalava ◽  
N. V. Yeshniyazov ◽  
V. V. Medovchshikov ◽  
E. R. Khasanova
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mechanism Of Action ◽  
Systemic Disease ◽  
Central Element ◽  
Sglt2 Inhibitors ◽  
Diagnostic Methods

Type 2 diabetes mellitus (T2DM) has gone beyond the professional interests of one specialty. T2DM, cardiovascular (CV) diseases and chronic kidney disease, considered from the standpoint of a single cardio-reno-metabolic continuum, place a heavy economic burden on society. At the same time, the improvement of diagnostic methods and medical technologies led to distinct decrease in the frequency and mortality from a number of complications of T2DM, including myocardial infarction and stroke, but other states took their place. Thus, heart failure (HF) has taken the position of one of the most frequent complications with average prevalence of 24–40 % and significant predominance of HF with preserved ejection fraction (HFpEF). According to this paradigm, HFpEF is not a disease of diastolic dysfunction, but a systemic disease, the central element of which is impaired renal function. All this together has a potential value for choosing the optimal therapy. In recent years the results of specially designed studies assessing the CV-safety of antidiabetic drugs from the groups of dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like preptide-1 (GLP-1) receptor agonists and sodium – glucose co-transporter-2 (SGLT2) inhibitors have become known. These drugs, except for SGLT2 inhibitors, by their mechanism of action affecting insulin resistance and hyperglycemia, demonstrated neutral or negative result on the frequency of hospitalizations due to HF. The EMPA-REG OUTCOME study with SGLT2, which has a special insulin-independent mechanism of action, demonstrated not only the efficacy and CV-safety of the drug in the form of a decrease in CV mortality by 38 %, but also a decrease in hospitalizations for HF by 35 %. Further studies with SGLT2 inhibitors confirmed positive effect on HF, indicating a class effect of the drugs. The recently completed study DECLARE-TIMI 58 proved the advantages of using dapagliflozin for the primary and secondary prevention of HF. This review highlights the prevalence of HF in diabetes mellitus, a new concept of the pathophysiology of HF, the main groups of sugar-lowering drugs and their effect on CV outcomes, in particular on HF. 

scholarly journals Clinical implementetion of vildagliptin: data from recent studies comparing incretin-based medications

2014 ◽  
Vol 17 (1) ◽  
pp. 81-84 ◽  
Author(s):  
Elena Valer'evna Biryukova
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mechanism Of Action ◽  
Evidence Base ◽  
Therapeutic Options ◽  
Efficacy And Safety ◽  
Current Article ◽  
Unique Mechanism

The introduction of DPP-4 inhibitors substantially increased therapeutic options for type 2 diabetes mellitus (T2DM). The unique mechanism of action allows using these agents both as monotherapy and in combination with conventional anti-diabetes drugs. Evidence base for efficacy and safety of DPP-4 inhibitors deepens every year, but to date only a few studies addressed direct comparison between individual agents within this pharmacological class. Current article presents data from the studies comparing vildagliptin with other DPP-4 inhibitors, as well as GLP-1 agonists.

Sodium-glucose co-transporter 2 inhibitors and cardiovascular outcomes: A systematic review and meta-analysis

2018 ◽  
Vol 25 (5) ◽  
pp. 495-502 ◽  
Author(s):  
Muhammad Shariq Usman ◽  
Tariq Jamal Siddiqi ◽  
Muhammad Mustafa Memon ◽  
Muhammad Shahzeb Khan ◽  
Wasiq Faraz Rawasia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Meta Analysis ◽  
Cardiovascular Effects ◽  
Sglt2 Inhibitors ◽  
Cardiac Events ◽  
Adverse Cardiac Events

Background The risks and benefits of sodium-glucose co-transporter 2 (SGLT2) inhibitors on cardiovascular outcomes have not been well established. We pooled evidence from all available clinical trials to assess the cardiovascular effects of this drug. Design A systematic review and meta-analysis of randomised controlled trials. Methods We queried electronic databases (MEDLINE, Scopus, CENTRAL and clinicaltrials.gov) from their inception to July 2017 for published and unpublished placebo controlled trials of SGLT2 inhibitors. Only studies with a follow-up period of at least 24 weeks and reporting at least one cardiovascular outcome were included. Results from trials were presented as odds ratios (ORs) with 95% confidence intervals (CIs) and were pooled using a random-effects model. Results Thirty-five eligible studies (canagliflozin, nine; empagliflozin, eight; dapagliflozin, 18), consisting of 34,987 patients with type 2 diabetes mellitus were included. Pooled results show that SGLT2 inhibitors, when compared to placebo, significantly reduce all-cause mortality (OR 0.79, 95% CI 0.70–0.89; P < 0.001), major adverse cardiac events (OR 0.8, 95% CI 0.76–0.92; P < 0.001), non-fatal myocardial infarction (OR 0.85, 95% CI 0.73–0.98; P = 0.03) and heart failure/hospitalisation for heart failure (OR 0.67, 95% CI 0.59–0.76; P < 0.001) in patients with type 2 diabetes mellitus. No significant difference was noted in the occurrence of stroke (OR 1.02, 95% CI 0.85–1.21; P = 0.87), atrial fibrillation (OR 0.61, 95% CI 0.31–1.19; P = 0.15) or unstable angina (OR 0.95, 95% CI 0.73–1.25; P = 0.73). In addition, there was no heterogeneity between different drugs in the SGLT2 inhibitor class for all of the clinical outcomes studied ( I2 = 0). Conclusions SGLT2 inhibitors significantly reduce the incidence of mortality, major adverse cardiac events, non-fatal myocardial infarction and heart failure in patients with type 2 diabetes mellitus. Subtypes of SGLT2 inhibitors appear to have similar cardiovascular effects.

scholarly journals A REVIEW ON PHARMACOLOGY AND THERAPEUTIC EFFECTS OF EMPAGLIFLOZIN IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

2020 ◽  
pp. 16-21
Author(s):  
AJAY CHADEVE
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mechanism Of Action ◽  
Therapeutic Effects ◽  
Therapeutic Benefits ◽  
Sodium Glucose Cotransporter ◽  
Unique Mechanism

Empagliflozin, a sodium glucose cotransporter 2 inhibitor, a newer class of antihyperglycemic agent, which offers the convenience of once-daily oral administration and carries a low inherent risk of hypoglycemia as a result of its unique mechanism of action, enabling it to be used as monotherapy and as an adjunct with other antidiabetic drugs. Empagliflozin has a unique mechanism of action by inhibiting glucose and sodium reabsorption in the proximal tubule of the kidney; they induce urinary glucose excretion and natriuresis. In patients with diabetes, empagliflozin results in glucose lowering, blood pressure (BP) reduction and weight loss. Empagliflozin reduced cardiovascular morbidity and mortality in patient with type 2 diabetes mellitus and established cardiovascular disease in the EMPA-REG OUTCOME trial®. The recommended starting dosage of empagliflozin is 10 mg daily. The dosage may be increased to a maximum of 25 mg/day in patients tolerating empagliflozin 10 mg/day. The most common adverse effect observed with empagliflozin (sodium glucose cotransporter 2 inhibitors) is an increment in mycotic genital infections. In this review article, we discussed the pharmacological properties, therapeutic effects, and adverse events that are associated with the administration of empagliflozin in patients with type 2 diabetes mellitus. In conclusion, empagliflozin provides greater therapeutic benefits in the management of type 2 diabetes mellitus and reduce the associated cardiovascular risk factors such as blood pressure (BP) and weight.

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