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Comprehensive review of SGLT2 inhibitors’ efficacy through their diuretic mode of action in diabetic patients

SGLT2 inhibitors (SGLT2i) are now the mainstay therapy for both diabetes and heart failure. Post-hoc publications, meta-analysis, and conference presentations of the eight SGLT2i Cardiovascular Outcomes trials (CVOTS) done in diabetic patients constantly echo that this class of drug decreases mortal...

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Autor principal: Lam-Chung, Cesar Ernesto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10400285/
https://www.ncbi.nlm.nih.gov/pubmed/37547306
http://dx.doi.org/10.3389/fendo.2023.1174692
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author Lam-Chung, Cesar Ernesto
author_facet Lam-Chung, Cesar Ernesto
author_sort Lam-Chung, Cesar Ernesto
collection PubMed
description SGLT2 inhibitors (SGLT2i) are now the mainstay therapy for both diabetes and heart failure. Post-hoc publications, meta-analysis, and conference presentations of the eight SGLT2i Cardiovascular Outcomes trials (CVOTS) done in diabetic patients constantly echo that this class of drug decreases mortality, reduces cardiovascular events, and prevents heart failure and kidney disease. This review of medical agencies’ SGLT2i analysis (FDA and EMA) helps to understand the reality of SGLT2i results in those trials, avoiding to consider observational and statistically undemonstrated endpoints as validated. They also confirmed the unique diuretic mode of action of SGLT2i, promoting osmotic diuresis, and its potential adverse events secondary to hypovolemia and hematocrit increase. They also support the understanding that the beliefs in SGLT2i morbi-mortality benefits are largely overstated mostly based on undemonstrated endpoints. Finally, it is clear that SGLT2i’s antidiabetic action, secondary to its renal mode of action, plateaued after a few months and decreased strongly over time, questioning its long-term goal of maintaining diabetic patients’ HbA1c below 7%. Also, this effect in patients with renal impairment is quasi null. We think that this review would be very helpful to every physician treating diabetic patients to better balance belief and reality of SGLT2i prescription effects.
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spelling pubmed-104002852023-08-04 Comprehensive review of SGLT2 inhibitors’ efficacy through their diuretic mode of action in diabetic patients Lam-Chung, Cesar Ernesto Front Endocrinol (Lausanne) Endocrinology SGLT2 inhibitors (SGLT2i) are now the mainstay therapy for both diabetes and heart failure. Post-hoc publications, meta-analysis, and conference presentations of the eight SGLT2i Cardiovascular Outcomes trials (CVOTS) done in diabetic patients constantly echo that this class of drug decreases mortality, reduces cardiovascular events, and prevents heart failure and kidney disease. This review of medical agencies’ SGLT2i analysis (FDA and EMA) helps to understand the reality of SGLT2i results in those trials, avoiding to consider observational and statistically undemonstrated endpoints as validated. They also confirmed the unique diuretic mode of action of SGLT2i, promoting osmotic diuresis, and its potential adverse events secondary to hypovolemia and hematocrit increase. They also support the understanding that the beliefs in SGLT2i morbi-mortality benefits are largely overstated mostly based on undemonstrated endpoints. Finally, it is clear that SGLT2i’s antidiabetic action, secondary to its renal mode of action, plateaued after a few months and decreased strongly over time, questioning its long-term goal of maintaining diabetic patients’ HbA1c below 7%. Also, this effect in patients with renal impairment is quasi null. We think that this review would be very helpful to every physician treating diabetic patients to better balance belief and reality of SGLT2i prescription effects. Frontiers Media S.A. 2023-07-20 /pmc/articles/PMC10400285/ /pubmed/37547306 http://dx.doi.org/10.3389/fendo.2023.1174692 Text en Copyright © 2023 Lam-Chung https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Lam-Chung, Cesar Ernesto
Comprehensive review of SGLT2 inhibitors’ efficacy through their diuretic mode of action in diabetic patients
title Comprehensive review of SGLT2 inhibitors’ efficacy through their diuretic mode of action in diabetic patients
title_full Comprehensive review of SGLT2 inhibitors’ efficacy through their diuretic mode of action in diabetic patients
title_fullStr Comprehensive review of SGLT2 inhibitors’ efficacy through their diuretic mode of action in diabetic patients
title_full_unstemmed Comprehensive review of SGLT2 inhibitors’ efficacy through their diuretic mode of action in diabetic patients
title_short Comprehensive review of SGLT2 inhibitors’ efficacy through their diuretic mode of action in diabetic patients
title_sort comprehensive review of sglt2 inhibitors’ efficacy through their diuretic mode of action in diabetic patients
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10400285/
https://www.ncbi.nlm.nih.gov/pubmed/37547306
http://dx.doi.org/10.3389/fendo.2023.1174692
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