Positioning SGLT2 Inhibitors/Incretin-Based Therapies in the Treatment Algorithm

Wilding, John PH ORCID: 0000-0003-2839-8404, Rajeev, Surya Panicker and DeFronzo, Ralph A (2016) Positioning SGLT2 Inhibitors/Incretin-Based Therapies in the Treatment Algorithm. DIABETES CARE, 39 (Supple). S154-S164.

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Abstract

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recent addition to the therapeutic options available for the treatment of type 2 diabetes and became available after the introduction of incretin-based therapies, dipeptidyl peptidase 4 inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1 RAs). These agents have potential advantages with regard to their weight loss-promoting effect, low risk of hypoglycemia, reduction in blood pressure, and reduction in cardiovascular events in high-risk patients (with empagliflozin). Apart from these clinically important outcomes, they may also correct core defects present in type 2 diabetes (i.e., improvement in β-cell function and insulin sensitivity). They do, however, have some adverse effects, notably, nausea with GLP-1 RAs and genital tract infections and potential for volume depletion with SGLT2i. Whether incretin-based therapies are associated with an increased risk of pancreatitis is unclear. Most recently, diabetic ketoacidosis has been reported with SGLT2i. Therefore, a key clinical question in relation to guidelines is whether these clinical advantages, in the context of the adverse effect profile, outweigh the additional cost compared with older, more established therapies. This article reviews the therapeutic rationale for the use of these newer drugs for diabetes treatment, considers their place in current guidelines, and discusses how this may change as new data emerge about their long-term efficacy and safety from ongoing outcome trials.

Item Type:	Article
Uncontrolled Keywords:	Humans, Diabetes Mellitus, Type 2, Hypoglycemia, Benzhydryl Compounds, Glucosides, Receptors, Glucagon, Hypoglycemic Agents, Drug Therapy, Combination, Algorithms, Sodium-Glucose Transporter 2, Incretins, Dipeptidyl-Peptidase IV Inhibitors, Sodium-Glucose Transporter 2 Inhibitors
Depositing User:	Symplectic Admin
Date Deposited:	26 Oct 2016 11:11
Last Modified:	19 Jan 2023 07:27
DOI:	10.2337/dcS15-3005
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3004020