TY - JOUR
T1 - Sodium glucose cotransporter (SGLT)-2 inhibitors: Do we need them for glucose-lowering, for cardiorenal protection or both?
AU - Scholtes, Rosalie A.
AU - van Baar, Michaël J. B.
AU - Lytvyn, Yuliya
AU - Bjornstad, Petter
AU - Nieuwdorp, Max
AU - Cherney, David Z. I.
AU - van Raalte, Daniël H.
PY - 2019
Y1 - 2019
N2 - Sodium glucose cotransporter (SGLT)-2 inhibitors are the newest addition to our treatment armamentarium for the management of hyperglycemia in type 2 diabetes. Glucose-lowering per se reduces the risk of microvascular complications, but not the risk of cardiovascular disease, including heart failure and cardiovascular mortality. Also, even when embedded in optimal cardiovascular prevention, a large residual risk remains with respect to progression of diabetic kidney disease. SGLT-2 inhibitors lower blood glucose levels by inducing glucosuria. Through various proposed mechanisms, among which diuretic and natriuretic effects, SGLT-2 inhibitors decrease heart failure hospitalization, reduce cardiovascular mortality, and mitigate progression of diabetic kidney disease. In this perspective, we will discuss the glucose-lowering and other protective effects of SGLT-2 inhibitors on the cardiorenal axis, both in primary and secondary prevention. By comparing the glycemic and pleiotropic effects of these agents to other glucose-lowering drugs, we will address questions around whether SGLT-2 inhibitors should be considered primarily as glucose-lowering agents, cardiorenal drugs or both.
AB - Sodium glucose cotransporter (SGLT)-2 inhibitors are the newest addition to our treatment armamentarium for the management of hyperglycemia in type 2 diabetes. Glucose-lowering per se reduces the risk of microvascular complications, but not the risk of cardiovascular disease, including heart failure and cardiovascular mortality. Also, even when embedded in optimal cardiovascular prevention, a large residual risk remains with respect to progression of diabetic kidney disease. SGLT-2 inhibitors lower blood glucose levels by inducing glucosuria. Through various proposed mechanisms, among which diuretic and natriuretic effects, SGLT-2 inhibitors decrease heart failure hospitalization, reduce cardiovascular mortality, and mitigate progression of diabetic kidney disease. In this perspective, we will discuss the glucose-lowering and other protective effects of SGLT-2 inhibitors on the cardiorenal axis, both in primary and secondary prevention. By comparing the glycemic and pleiotropic effects of these agents to other glucose-lowering drugs, we will address questions around whether SGLT-2 inhibitors should be considered primarily as glucose-lowering agents, cardiorenal drugs or both.
KW - SGLT-2 inhibition
KW - diabetic kidney disease
KW - glycemic control
KW - heart failure
KW - number-needed-to-treat
KW - primary prevention
KW - secondary prevention
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85063566692&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30843294
U2 - https://doi.org/10.1111/dom.13692
DO - https://doi.org/10.1111/dom.13692
M3 - Review article
C2 - 30843294
SN - 1462-8902
VL - 21
SP - 24
EP - 33
JO - Diabetes, obesity & metabolism
JF - Diabetes, obesity & metabolism
IS - S2
ER -