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Review
. 2019 Oct 15;191(41):E1128-E1135.
doi: 10.1503/cmaj.190047.

Sodium-glucose cotransporter inhibitors in type 2 diabetes: thinking beyond glucose lowering

Brendon L Neuen  1 , David Z Cherney  1 , Meg J Jardine  1 , Vlado Perkovic  2
Affiliations
Review

Sodium-glucose cotransporter inhibitors in type 2 diabetes: thinking beyond glucose lowering

Brendon L Neuen et al. CMAJ. .
No abstract available

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Conflict of interest statement

Competing interests: The George Institute for Global Health provides contract research services to Janssen for trials of SGLT2 inhibitors. Brendon Neuen has received travel support from Janssen. David Cherney has received honoraria from Boehringer Ingelheim, Eli Lilly, Merck, AstraZeneca, Sanofi, Merck, Mitsubishi Tanabe, AbbVie, Janssen, Bayer and Prometic, and has received operational funding for clinical trials from Boehringer Ingelheim, Eli Lilly, Merck, Janssen, Sanofi and AstraZeneca. Meg Jardine is responsible for research projects that have received unrestricted funding from Gambro, Baxter, CSL, Amgen, Eli Lilly and Merck; has served on advisory boards sponsored by Akebia, Baxter and Boehringer Ingelheim; and spoken at scientific meetings sponsored by Janssen, Amgen and Roche, with any consultancy, honoraria or travel support paid to her institution. Vlado Perkovic was the chair of a steering committee for a renal outcome study of an SGLT2 inhibitor (canagliflozin), serves on steering committees for AbbVie, Boehringer Ingelheim, GlaxoSmithKline, Janssen and Pfizer; serves on advisory boards or speaks at scientific meetings for AbbVie, Astellas, AstraZeneca, Bayer, Baxter, Bristol–Myers Squibb, Boehringer Ingelheim, Durect, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Novo Nordisk, Pfizer, Pharmalink, Relypsa, Roche, Sanofi, Servier and Vitae; and has received personal fees for consulting and scientific presentations related to canagliflozin from Mitsubishi Tanabe and Mundipharma.

Figures

Figure 1:
Figure 1:
Major adverse cardiovascular events (MACE), defined as nonfatal myocardial infarction, nonfatal stroke or cardiovascular death (the size of each box is weighted using the inverse variance method). Note: CI = confidence interval, HR = hazard ratio, SGLT2 = sodium-glucose cotransporter-2.
Figure 2:
Figure 2:
Admission to hospital for heart failure (the size of each box is weighted using the inverse variance method). Note: CI = confidence interval, HR = hazard ratio, SGLT2 = sodium-glucose cotransporter-2.
Figure 3:
Figure 3:
Substantial loss of kidney function, ESKD or death from kidney disease. Substantial loss of kidney function was defined as doubling of serum creatinine level in the CREDENCE and EMPA-REG OUTCOME trials and sustained 40% decline in estimated glomerular filtration rate in the CANVAS Program and DECLARE-TIMI 58 trial. The size of each box is weighted using the inverse variance method. Note: CI = confidence interval, ESKD = end-stage kidney disease, HR = hazard ratio, SGLT2 = sodium-glucose cotransporter-2.
Figure 4:
Figure 4:
Summary of the overall approach to glucose-lowering medications in type 2 diabetes as recommended by the 2018 consensus report of the American Diabetes Association and European Association for the Study of Diabetes. Note: ASCVD = atherosclerotic cardiovascular disease, CKD = chronic kidney disease, CVD = cardiovascular disease, eGFR = estimated glomerular filtration rate, GLP-1 = glucagon-like peptide-1, HbA1c = glycated hemoglobin, SGLT2 = sodium-glucose cotransporter-2.
See this image and copyright information in PMC

References

    1. Cefalu WT, Kaul S, Gerstein HC, et al. Cardiovascular outcomes trials in type 2 diabetes: Where do we go from here? Reflections from a diabetes care editors’ expert forum. Diabetes Care 2018;41:14–31. - PMC - PubMed
    1. Vaduganathan M, Sathiyakumar V, Singh A, et al. Prescriber patterns of SGLT2i after expansions of U.S. Food and Drug Administration labeling. J Am Coll Cardiol 2018;72:3370–2. - PubMed
    1. Heerspink HJ, Perkins BA, Fitchett DH, et al. Sodium glucose cotransporter 2 inhibitors in the treatment of diabetes mellitus: cardiovascular and kidney effects, potential mechanisms, and clinical applications. Circulation 2016; 134:752–72. - PubMed
    1. Heerspink HJ, Kosiborod M, Inzucchi SE, et al. Renoprotective effects of sodium-glucose cotransporter-2 inhibitors. Kidney Int 2018;94:26–39. - PubMed
    1. Neuen BL, Ohkuma T, Neal B, et al. Effect of canagliflozin on renal and cardiovascular outcomes across different levels of albuminuria: data from the CANVAS Program. J Amer Soc Nephrol 2019. Sept. 7 10.1681/ASN.2019010064. - DOI - PMC - PubMed

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