COMMENTARY

Anne Peters: The Year in Diabetes

Anne L. Peters, MD; Mark Harmel, MPH

Disclosures

December 10, 2013

In This Article

First in a New Class of Drugs

When I first heard about the mechanism of action of the new class of sodium glucose cotransporter 2 (SGLT-2) inhibitors, it struck me as odd. The SGLT-2 inhibitor is a pill that works in a unique way: As blood glucose levels increase, the drug causes you to eliminate glucose in the urine to decrease the elevated blood glucose levels. Now, I trained in the day when we sometimes used urine glucose testing, so these drugs obviously would alter such tests.

No matter the mechanism, however, these new drugs lower glucose levels in the blood. Canagliflozin (Invokana®) is currently the only drug in the class approved by the US Food and Drug Administration (FDA) in the United States, but another SGLT-2 inhibitor, dapagliflozin, is approved in the European Union and is in line for an FDA rehearing. A third agent, empagliflozin, has been submitted to the FDA for review.

The most significant side effect associated with these drugs is an increase in mycotic vaginitis that occurs in about 11% of women in clinical trials.[20] The drug can also cause urinary tract infections, at a rate of about 6%, and mycotic balanitis at a rate of 3% in men. Other effects are initial dizziness and orthostatic symptoms, so doses of concurrent diuretics and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers may need to be reduced. The drug causes a small increase in LDL cholesterol, and the long-term cardiovascular effects of these drugs are unknown. You may also want to warn your patients that there may be new and unknown risks associated with this drug.

You can find more details about SGLT-2 inhibitors in my recent Medscape video.

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