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Review
. 2019 Oct;10(5):1719-1731.
doi: 10.1007/s13300-019-00678-z. Epub 2019 Aug 13.

What Next After Metformin? Thinking Beyond Glycaemia: Are SGLT2 Inhibitors the Answer?

Marc Evans  1 , Angharad R Morgan  2 , Zaheer Yousef  3
Affiliations
Review

What Next After Metformin? Thinking Beyond Glycaemia: Are SGLT2 Inhibitors the Answer?

Marc Evans et al. Diabetes Ther. 2019 Oct.

Abstract

The prevalence of type 2 diabetes continues to increase, along with a proliferation of glucose-lowering treatment options. There is universal agreement in the clinical community for the use of metformin as the first-line glucose-lowering therapy for the majority of patients. However, controversy exists regarding the choice of second-line therapy once metformin is no longer effective. The most recent treatment consensus focuses on the presence of cardiovascular disease, heart failure or kidney disease as a determinant of therapy choice. The majority of patients in routine practice, however, do not fall into such categories. Heart failure and kidney disease represent significant clinical and cost considerations in patients with type 2 diabetes and have a close pathophysiological association. Recent data has illustrated that sodium-glucose transporter 2 (SGLT2) inhibitor therapy can reduce the burden of heart failure and the progression of renal disease across a wide range of patients including those with and without established disease, supported by an increased understanding of the mechanistic effects of these agents. Furthermore, there is growing evidence to illustrate the overall safety profile of this class of agents and support the benefit-risk profile of SGLT2 inhibitors as a preferred option following metformin monotherapy failure, with respect to both kidney disease progression and heart failure outcomes.

Keywords: Cardiorenal disease; Cardiovascular; Chronic kidney disease; Heart failure; Sodium-glucose transporter 2 inhibitor; Type 2 diabetes mellitus.

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Figures

Fig. 1
Fig. 1
Increasing disease burden and cost with CKD progression. There is an increase in adverse outcomes (CV events per 100 person years) and annual healthcare costs (USD) with CKD progression. CKD chronic kidney disease, CV cardiovascular
Fig. 2
Fig. 2
The link between heart failure and kidney disease in type 2 diabetes
Fig. 3
Fig. 3
SGLT2 inhibitor cardiorenal protection mechanistic overview. SBP systolic blood pressure
See this image and copyright information in PMC

References

    1. Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14(2):88–98. doi: 10.1038/nrendo.2017.151. - DOI - PubMed
    1. International Diabetes Federation. IDF diabetes atlas—8th edition. 2017. https://www.diabetesatlas.org/. Accessed 1 July 2019. - PubMed
    1. Scully T. Diabetes in numbers. Nature. 2012;485(7398):S2–S3. doi: 10.1038/485S2a. - DOI - PubMed
    1. Guillausseau PJ, Meas T, Virally M, Laloi-Michelin M, Medeau V, Kevorkian JP. Abnormalities in insulin secretion in type 2 diabetes mellitus. Diabetes Metab. 2008;34(Suppl 2):S43–S48. doi: 10.1016/s1262-3636(08)73394-9. - DOI - PubMed
    1. Medscape. Type 2 diabetes mellitus. 2019. https://emedicine.medscape.com/article/117853-overview. Accessed 1 July 2019.

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