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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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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2023
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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. |
format | Online Article Text |
id | pubmed-10400285 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
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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