Sodium-glucose Co-transporter 2 Inhibitors for the Treatment of Type 2 Diabetes: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic disease resulting from insufficient insulin production or inadequate cellular sensitivity to insulin. It is associated with substantial disease burden both internationally and in Canada. In 2017, 7.3% of Canadians reported being diagnosed with diabetes, the majority of which (approximately 90%) were classified as T2DM. T2DM results in high blood glucose and is associated with increased risk of various medical conditions or complications including cardiovascular disease, blindness, renal disease, non-traumatic amputation, and death. The healthcare and other societal costs associated with diabetes are substantial.Management strategies are multifaceted, and can include physical activity, nutrition therapy, and pharmacological management. Typically, treatment for type 2 diabetes focuses on diet and exercise, followed by metformin. If insufficient, second-line treatments are considered. Several second-line treatments are available, with different mechanisms of action, including sulfonylureas, insulins, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 analogues and sodium-glucose co-transporter 2 inhibitors. Sodium-glucose co-transporter 2 inhibitors increase the amount of glucose excreted through the urine, thereby reducing blood glucose levels. Four sodium-glucose co-transporter 2 inhibitors are currently licensed for use in Canada: canagliflozin (INVOKANA©) 100 mg and 300 mg, empagliflozin (JARDIANCE©) 10 mg and 25 mg),…
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