Sodium glucose transporter 2 (sglt2) inhibitors: Current status in clinical practice

Sodium glucose transporter 2 (SGLT2) inhibitors including dapagliflozin, canagliflozin and empagliflozin act by a novel insulin-independent mechanism by blocking glucose reabsorption in the proximal convoluted tubules resulting in markedly increased glycosuria, a mechanism not limited by the degree of insulin resistance or beta-cell dysfunction, and which results in weight loss due to loss of 300 to 400kcal/day. Currently dapagliflozin, canagliflozin and empagliflozin are the three primary drugs, which represent this group. They have comparable efficacy in HbA1c reduction as compared to metformin, sulfonylureas and slightly better than gliptins. They have additional beneficial effects on blood pressure and lipids. Their use is not limited by the degree of insulin resistance or beta-cell dysfunction, and hence can be used at any stage of diabetes, along with a potential for use in type-1 diabetes. Long term safety and impact on microvascular and macrovascular complications is likely to be favourable, data on which should be available in the next few years.