What is the role of selective sodium-glucose transporter-2 (SGLT-2) inhibitors in the treatment of type 2 diabetes mellitus (DM)?

Updated: Oct 23, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

Canagliflozin is the first SGLT-2 inhibitor approved in the United States. [193, 194] SGLT-2 inhibition lowers the renal glucose threshold (ie, the plasma glucose concentration that exceeds the maximum glucose reabsorption capacity of the kidney). Lowering the renal glucose threshold results in increased urinary glucose excretion. A second SGLT-2 inhibitor, dapagliflozin (Farxiga), was approved by the FDA in January 2014, [195, 196] and another, empagliflozin, approved in August, 2014. [197, 198]

Dosage adjustments are required for canagliflozin in patients who have renal impairment (ie, estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2). Dapagliflozin should not be used if eGFR is < 60 mL/min/1.73 m2. Also consider lowering the dose of insulin or insulin secretagogues to reduce the risk of hypoglycemia when coadministered with SGLT-2 inhibitors.


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