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2015 ; 8
(ä): 543-54
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SGLT2 inhibitors - an insulin-independent therapeutic approach for treatment of
type 2 diabetes: focus on canagliflozin
#MMPMID26609242
Seufert J
Diabetes Metab Syndr Obes
2015[]; 8
(ä): 543-54
PMID26609242
show ga
Despite the availability of a great variety of medications, a significant
proportion of people with type 2 diabetes mellitus (T2DM) are not able to achieve
or maintain adequate glycemic control. Beyond improved glucose control, novel
treatments would ideally provide a reduction of cardiovascular risk, with a
favorable impact on excess weight, and a low intrinsic hypoglycemia risk, as well
as a synergistic mechanism of action for broad combination therapy. With the
development of sodium glucose cotransporter 2 (SGLT2) inhibitors, an antidiabetic
pharmacologic option has recently become available that comes close to meeting
these requirements. For the first time, SGLT2 inhibitors offer a therapeutic
approach acting directly on the kidneys without requiring insulin secretion or
action. Canagliflozin, dapagliflozin, and empagliflozin are the SGLT2 inhibitors
approved to date. Taken once a day, these medications can be combined with all
other antidiabetic medications including insulin, due to their
insulin-independent mechanism of action, with only a minimal risk of
hypoglycemia. SGLT2 inhibitors provide additional reductions in body weight and
blood pressure due to the therapeutically induced excretion of glucose and sodium
through the kidneys. These "concomitant effects" are particularly interesting
with regard to the increased cardiovascular risk in T2DM. In many cases, T2DM
treatment requires a multidimensional approach where the treatment goals have to
be adapted to the individual patient. While there is a consensus on the use of
metformin as a first-line drug therapy, various antidiabetics are used for
treatment intensification. New mechanisms of action like that of SGLT2 inhibitors
such as canagliflozin, which can be used both in early and late stages of
diabetes, are a welcome addition to expand the treatment options for patients at
every stage of T2DM. The efficacy and tolerability of canagliflozin have been
tested in an extensive clinical trial program described in this review article.