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SGLT2 Inhibition in the Diabetic Kidney-From Mechanisms to Clinical Outcome.

Clinical journal of the American Society of Nephrology : CJASN
January 1, 1970
Erik J M van Bommel et al. (6 authors)
Journal ArticleReviewHuman Study
Extracted Claims (9)
InterventionDirectionEndpointPopulationDosageImpactClaim #
sodium-glucose cotransporter type 2 inhibitors
increase
glycemic control
patients with type 2 diabetes
-
effectively improve
#1
sodium-glucose cotransporter type 2 inhibitors
decrease
body weight
patients with type 2 diabetes
-
favorably affect
#2
sodium-glucose cotransporter type 2 inhibitors
decrease
BP
patients with type 2 diabetes
-
favorably affect
#3
sodium-glucose cotransporter type 2 inhibitors
decrease
serum uric acid
patients with type 2 diabetes
-
favorably affect
#4
sodium-glucose cotransporter type 2 inhibitors
decrease
glomerular hyperfiltration
patients with type 2 diabetes
-
favorably affect
#5
empagliflozin
increase
renal outcomes
patients with type 2 diabetes and established cardiovascular disease
-
improved
#6
empagliflozin
increase
cardiovascular outcomes
patients with type 2 diabetes and established cardiovascular disease
-
improved
#7
liraglutide
increase
cardiovascular outcome
patients with type 2 diabetes
-
improve
#8
semaglutide
increase
cardiovascular outcome
patients with type 2 diabetes
-
improve
#9
Abstract

Diabetic kidney disease not only has become the leading cause for ESRD worldwide but also, highly contributes to increased cardiovascular morbidity and mortality in type 2 diabetes. Despite increased efforts to optimize renal and cardiovascular risk factors, like hyperglycemia, hypertension, obesity, and dyslipidemia, they are often insufficiently controlled in clinical practice. Although current drug interventions mostly target a single risk factor, more substantial improvements of renal and cardiovascular outcomes can be expected when multiple factors are improved simultaneously. Sodium-glucose cotransporter type 2 in the renal proximal tubule reabsorbs approximately 90% of filtered glucose. In type 2 diabetes, the maladaptive upregulation of sodium-glucose cotransporter type 2 contributes to the maintenance of hyperglycemia. Inhibiting these transporters has been shown to effectively improve glycemic control through inducing glycosuria and is generally well tolerated, although patients experience more genital infections. In addition, sodium-glucose cotransporter type 2 inhibitors favorably affect body weight, BP, serum uric acid, and glomerular hyperfiltration. Interestingly, in the recently reported first cardiovascular safety trial with a sodium-glucose cotransporter type 2 inhibitor, empagliflozin improved both renal and cardiovascular outcomes in patients with type 2 diabetes and established cardiovascular disease. Because the benefits were seen rapidly after initiation of therapy and other glucose-lowering agents, with the exception of liraglutide and semaglutide, have not been able to improve cardiovascular outcome, these observations are most likely explained by effects beyond glucose lowering. In this mini review, we present the drug class of sodium-glucose cotransporter type 2 inhibitors, elaborate on currently available renal and cardiovascular outcome data, and discuss how the effects of these agents on renal physiology may explain the data.

Medical Subject Headings (MeSH)
AlbuminuriaBenzhydryl CompoundsBlood GlucoseBlood PressureCanagliflozinCardiovascular DiseasesDiabetes Mellitus, Type 2Diabetic NephropathiesGlucoseGlucosidesHumansHypoglycemic AgentsLipid MetabolismSodium-Glucose Transporter 2Sodium-Glucose Transporter 2 InhibitorsWeight Loss
Study Links
PubMed ID28254770
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