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Sodium glucose cotransporter (SGLT)‐2 inhibitors: Do we need them for glucose‐lowering, for cardiorenal protection or both?
Author(s) -
Scholtes Rosalie A.,
Baar Michaël J. B.,
Lytvyn Yuliya,
Bjornstad Petter,
Nieuwdorp Max,
Cherney David Z. I.,
Raalte Daniël H.
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13692
Subject(s) - cotransporter , medicine , endocrinology , sodium , chemistry , organic chemistry
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.