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Diabetes mellitus and cardiovascular disease in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a new class of glucose-lowering drugs. They lower glucose by inhibiting the reabsorption of glucose at the proximal renal tubule. Normally, virtually all filtered glucose is reabsorbed, leaving none excreted into the urine. Inhibition of renal glucose reabsorption by blocking the glucose transport protein SGLT2 results in urinary glucose excretion and reduction in hyperglycemia. These drugs work independently of insulin and can therefore be used with other classes of glucose-lowering medication. Randomized, controlled studies demonstrate that SGLT2 inhibitors result in mean reductions of hemoglobin A1C levels of –0.69% (95% CI, −0.75 to −0.62). In addition body weight is reduced by a mean of −2.1 kg (95% CI, −2.3 to −2.0) and systolic blood pressure by a mean of −3.9 mmHg (95% CI, −4.6 to −3.3) (145).
Management of Obesity-Associated Type 2 Diabetes
Published in Emmanuel C. Opara, Sam Dagogo-Jack, Nutrition and Diabetes, 2019
Wanda C. Lakey, Lillian F. Lien, Mark N. Feinglos
Inhibition of sodium-glucose cotransporter-2 (SGLT2) decreases renal reabsorption of filtered glucose and increases urinary excretion of glucose. Available SGLT-2 inhibitors include canagliflozin, dapagliflozin, and empagliflozin. In addition to improving glycemic control, SGLT-2 inhibitors also decrease blood pressure and weight [149]. Empagliflozin is the sole SGLT-2 inhibitor with the approved indication for reduction of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease [150,151]. Hypoglycemia can occur with SGLT-2 inhibitor use if combined with sulfonylureas or insulin. Dehydration, acute kidney injury, and hypotension may also occur with use. SGLT-2 inhibitors have been associated with an increased risk of genitourinary infections. Diabetic ketoacidosis has been reported with SGLT-2 inhibitors [150]. Increased risks associated with SGLT-2 inhibitor use have also been reported for amputations (canagliflozin), fractures (canagliflozin), and bladder cancer (dapagliflozin) [152,153].
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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Sarashina A, Ueki K, Sasaki T, et al. Effect of renal impairment on the pharmacokinetics, pharmacodynamics, and safety of empagliflozin, a sodium glucose cotransporter 2 inhibitor, in Japanese patients with type 2 diabetes mellitus. Clin Ther. 2014; 36(11): 1606–15.
The anti-hypertensive effects of sodium-glucose cotransporter-2 inhibitors
Published in Expert Review of Cardiovascular Therapy, 2023
Luxcia Kugathasan, Lisa Dubrofsky, Andrew Advani, David Z.I. Cherney
RAAS blockers have been the standard of care in patients with diabetes and CKD [7]. However, despite intervention with RAAS blockade, many patients do not reach target BP and have residual CV and kidney risk [8,9]. The introduction of sodium-glucose cotransporter 2 (SGLT2) inhibitors has fundamentally changed clinical practice due to their cardio-kidney protective effects (Figure 2) [10–12]. These agents have also been shown to lower BP. The aim of this review is to highlight evidence of BP reduction with use of SGLT2 inhibitors in high-risk patients with and without diabetes with CKD, CV disease, obesity, and hypertension, review possible antihypertensive mechanisms, and review the role of SGLT2 inhibitors as potentially adjunctive antihypertensive agents in clinical practice.
Efficacy and safety of finerenone for treatment of diabetic kidney disease: current knowledge and future perspective
Published in Expert Opinion on Drug Safety, 2022
Vincenzo Marzolla, Marco Infante, Andrea Armani, Manfredi Rizzo, Massimiliano Caprio
Sodium–glucose cotransporter-2 inhibitors (SGLT2is) are a relatively novel class of drug for treating T2DM that are recommended in T2DM patients with established cardiorenal disease, including T2DM patients with CKD [92]. Indeed, SGLT2is have been shown to significantly reduce cardiorenal events in patients with T2DM [93]. Sodium–glucose cotransporter-2 (SGLT2) is mainly localized in the proximal convoluted renal tubule, and mediates glucose reabsorption by the kidney. Inhibition of this cotransporter determines the excretion of glucose and sodium in the urine, reducing blood glucose levels, promoting osmotic diuresis, and favoring blood pressure reduction [94]. Finerenone exerts its renal protective effects in patients with T2DM and CKD by preserving eGFR, reducing inflammation, fibrosis, and albuminuria, while SGLT2i exert their renal protective effects through eGFR preservation, reduction of blood pressure and tubular/glomerular damage, improvement in albuminuria, and reduction of ischemic renal damage by promoting autophagy and mitochondrial biogenesis [95,96]. This point appears to be particularly important in the absence of evidence regarding whether the combination therapy, using a SGLT2i and finerenone, could lead to greater cardiorenal benefits than SGLT2i or finerenone monotherapies in patients with T2DM and CKD.
Specific FSTL1 polymorphism may determine the risk of cardiomyopathy in patients with acromegaly
Published in Acta Cardiologica, 2022
Suleyman Nahit Sendur, Tuncay Hazirolan, Busra Aydin, Incilay Lay, Mehmet Alikasifoglu, Tomris Erbas
The study was designed as a cross-sectional case research. The study was approved by the institutional noninterventional clinical research ethics board with the project no: GO 17/898 and was performed in accordance with the ethical standards of the Helsinki Declaration and its later amendments. Informed consent was obtained from all individual participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Forty-six consecutive acromegalic patients were included in the study. The patients who had a history of past cardiac surgery; any cardiac diseases that may affect heart morphology such as congenital heart diseases, valvular diseases, pulmonary hypertension, cardiac tumours; past medical history of myocarditis and any contraindication for MR imaging were excluded. The patients who had chronic kidney disease, congestive heart failure and/or chronic liver disease were excluded as well. Subjects that receiving thyroid hormone, gonadal steroid and/or glucocorticoid replacement were required to receive stable doses for at least last three months to include the study. None of the subjects with diabetes mellitus were on sodium-glucose cotransporter-2 inhibitor treatment.