Members of this family: Empagliflozin and Dapagliflozin
The History of Sodium -Glucose Co- Transporter 2 (SGLT2) inhibitors can be traced back to 1835, where a chemistry professor and his assistants identified a substance called phlorizin from the root bark of apple trees in his nursery. At the time phlorizin showed no medicinal value.
The ability of phlorizin to lower blood sugar was first described in 1886. Researchers also noticed that the substance caused the kidneys to release sugar into the urine. The sugar in urine was seen as a sign of diabetes.
In 1950 researchers showed that phlorizin in the intestines was able to block a process that played a role in the transport of glucose in blood. This discovery was important as a similar process happens in the kidneys.
Yale researchers in 1980 showed that phlorizin could lower blood glucose levels in diabetic rats who had part of their pancreases removed. This observation rekindled interest on the possible medicinal role of phlorizin.
There were challenges with converting phlorizin into a product that could be used as medicine. Japanese researchers pioneered this process. United States and European companies rapidly joined in and in 2012 the first SGLT2 inhibitor was registered and produced in Europe.
How do SGLT2 inhibitors work?
SGLT2 inhibitors lower blood sugar by blocking the re-uptake of glucose by the kidneys, causing glucose to be released in urine.
Kidneys sieve and remove waste products and things that the body does not need from blood ,while at the same time keeping and returning essential substances like glucose back into the blood stream. Unwanted products are excreted in urine.
Factors to consider when using SGLT2 inhibitors.
Risk of hypoglycaemia
Risk of hypoglycaemia with SGLT2 inhibitors is low. Use of SGLT2 inhibitors with other glucose lowering medications may increase risk of hypoglycaemia.
Glycaemic control
SGLT2 inhibitors have been shown to lower HbA1c by 0.7% -1 %.
Effect on weight
Medications belonging to this group have been shown to cause weight loss. Weight loss associated with SGLT2 inhibitors range between 2-3kg , lost over a period of 6 months from starting treatment.
Benefits to heart and kidneys
SGLT2 inhibitors provide both heart and kidney benefits for individuals with Type 2 Diabetes.
Medications in this group have been shown to lower rates of hospitalization and death from heart related conditions, for individuals with existing heart conditions and those at risk of developing one.
SGLT2 inhibitors have been shown to slow down progression of kidney failure. Medicines in this group have also been proven to lower blood pressure which is important for both heart and kidney health.
Cost
Cost remains a challenge for this group of medications as they remain unaffordable for individuals and healthcare systems in low-income settings.
Side effects
Urinary Tract Infections and Genital infections are a common side effects associated with SGLT2 inhibitors. This is due to sugar being excreted in urine. Infections include yeast infections in women , irritation and swelling of foreskin and head of the penis in men .
Dehydration, frequent urination (peeing more often) and low blood pressure are other common side effects associated with SGLT2 inhibitors.
A very rare and serious side effect associated with this group of drugs is a condition called Euglycemic Diabetes Ketoacidosis (EDKA). Left untreated the condition can lead to death.
Useful tips when using SGLT2 inhibitors.
- Let your Doctor know if you have a family history of bladder cancer.
- If you are ill or have an infection talk to your doctor about stopping treatment. This will help prevent EDKA.