Sodium–glucose co‐transporter 2 inhibitors: strength of evidence for a cardio‐renal‐metabolic therapy
Abstract
Sodium–glucose co-transporter 2 (SGLT2) inhibitors are potent antidiabetic agents for patients with type 2 diabetes mellitus (T2DM) that regulate glycaemic status through a non-insulin-dependent mechanism of stimulating glucose excretion in urine. SGLT2 inhibitor therapy is now a guideline-recommended approach for glycaemic control and cardiovascular risk reduction among high-risk T2DM patients. The SGLT2 inhibitors have had a serendipitous expedition into the arena of cardiovascular risk reduction and heart failure management in specific. The data from initial investigations of SGLT2 inhibitors demonstrated that apart from reducing hyperglycaemia, this medication class reduced arterial stiffness, vascular resistance, blood pressure, body weight, visceral adiposity, and albuminuria.1 These cardiovascular benefits prompted the evaluation of the impact of empagliflozin on cardiovascular outcomes among individuals with high-risk [having atherosclerotic cardiovascular diseases (ASCVD)] T2DM in the EMPA-REG OUTCOME trial.1 The results indicated a lower risk of adverse cardiovascular events and all-cause mortality among patients receiving empagliflozin compared with placebo. While glycaemic control is anticipated to contribute to cardiovascular risk reduction, antidiabetic agents more potent than SGLT2 inhibitors did not previously extend such a cardiovascular benefit. Spurred by the promising results, similar trials using dapagliflozin (DECLARE–TIMI 58), canagliflozin (CANVAS…
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