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Review
. 2017 Jan-Feb;21(1):210-230.
doi: 10.4103/2230-8210.196029.

Safe and pragmatic use of sodium-glucose co-transporter 2 inhibitors in type 2 diabetes mellitus: South Asian Federation of Endocrine Societies consensus statement

Sanjay Kalra  1 , Sujoy Ghosh  2 , A H Aamir  3 , Md Tofail Ahmed  4 , Mohammod Feroz Amin  4 , Sarita Bajaj  5 , Manash P Baruah  6 , Uditha Bulugahapitiya  7 , A K Das  8 , Mimi Giri  9 , Sonali Gunatilake  7 , Saeed A Mahar  10 , Md Faruque Pathan  4 , Nazmul Kabir Qureshi  11 , S Abbas Raza  12 , Rakesh Sahay  13 , Santosh Shakya  14 , Dina Shreshta  15 , Noel Somasundaram  16 , Manilka Sumanatilleke  17 , A G Unnikrishnan  18 , Achini Madushani Wijesinghe  16
Affiliations
Review

Safe and pragmatic use of sodium-glucose co-transporter 2 inhibitors in type 2 diabetes mellitus: South Asian Federation of Endocrine Societies consensus statement

Sanjay Kalra et al. Indian J Endocrinol Metab. 2017 Jan-Feb.

Abstract

Diabetes prevalence shows a continuous increasing trend in South Asia. Although well-established treatment modalities exist for type 2 diabetes mellitus (T2DM) management, they are limited by their side effect profile. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) with their novel insulin-independent renal action provide improved glycemic control, supplemented by reduction in weight and blood pressure, and cardiovascular safety. Based on the clinical outcomes with SGLT2i in patients with T2DM, treatment strategies that make a "good clinical sense" are desirable. Considering the peculiar lifestyle, body types, dietary patterns (long duration religious fasts), and the hot climate of the South Asian population, a unanimous decision was taken to design specific, customized guidelines for T2DM treatment strategies in these regions. The panel met for a discussion three times so as to get a consensus for the guidelines, and only unanimous consensus was included. After careful consideration of the quality and strength of the available evidence, the executive summary of this consensus statement was developed based on the American Association of Clinical Endocrinologists/American College of Endocrinology protocol.

Keywords: Canagliflozin; South Asia; dapagliflozin; diabetes mellitus; empagliflozin; glycosuria; hyperglycemia; sodium–glucose co-transporter 2.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Glucose homeostasis. GLUTs: Glucose transporters, SGLTs: Sodium–glucose co-transporters
Figure 2
Figure 2
Mechanism of action and effects of sodium–glucose co-transporter 2 inhibitors on the body. BP: Blood pressure, GLUTs: Glucose transporters, LDL-C: Low-density lipoproteins, SGLTs: Sodium–glucose co-transporters
Figure 3
Figure 3
Basic pharmacology of sodium–glucose co-transporter 2 inhibitors: (a) Renal threshold for glucose excretion and (b) ketogenesis. SGLT2i causing increased glycosuria and decreased IGR resulting in lipolysis and increased FFA concentration. Following hepatic uptake, FFA undergoes β-oxidation. The β-HB formed in liver is released in circulation and is then freely taken up by heart (in preference to FFA: dotted lines) and undergoes oxidative phosphorylation through TCAC. Excess acetyl-CoA restricts further formation of acetyl-CoA from pyruvate and from oxidation of fatty acids (dotted lines). This overall improves cardiac efficiency by releasing more oxygen and increasing hematocrit
Figure 4
Figure 4
Efficacy of sodium–glucose co-transporter 2 inhibitors in clinical studies.[7273] Cana: Canagliflozin, Dapa: Dapagliflozin, DPP-4i: Dipeptidyl peptidase 4 inhibitor, Empa: Empagliflozin, FPG: Fasting plasma glucose, GLP-1 RA: Glucagon-like peptide 1 receptor agent, INS: Insulin, MET: Metformin, SGLT2i: Sodium–glucose transporter inhibitor, SU: Sulfonylurea, TZD: Thiazolidinedione
Figure 5
Figure 5
Pragmatic use of sodium–glucose co-transporter inhibitors. AHA: Anti-hyperglycemic agents, MOA: Mechanism of action, SGLT2i: Sodium–glucose co-transporter inhibitors, T2DM: Type-2 diabetes mellitus
See this image and copyright information in PMC

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