SGLT2 INHIBITORS: PROMISING NEW DRUGS FOR TYPE 2 DIABETES MELLITUS

Dr. Abhijeet Bhagat, Dr. Deepak Bhosle, Dr. Asif Sayyed*, Dr. Vasundhara Bhople, Dr. Ayman Ali Khan, Dr. Zubair Quazi

ABSTRACT

Due to change in life style there is a growing pandemic of Type 2 diabetes mellitus. Currently it affects more than 3 million people worldwide and this number is expected to grow to more than 5 million by the year 2030. Sodium glucose transporter 2 (SGLT2) is a new class of antidiabetic drugs which unlike many other antidiabetic drugs acts by insulin dependent mechanism and hence less prone to cause clinically significant hypoglycemia. Canagliflozin is the prototype drug of this group. It was first approved by food and drug administration in 2013. Other SGLT2 inhibitors approved by FDA for type II diabetes mellitus are dapagliflozin, and empagliflozin. The mechanism of action of these drugs is by inhibition of SGLT2 which is a low- affinity, high capacity glucose transporter which is located in the proximal tubule in the kidneys. This co-transporter is responsible for majority of the glucose reab-sorption from proximal tubule. Inhibition of SGLT2 leads to increase in glucose excretion from proximal tubules of kidney. This increase in excretion consequently cause reduction in blood glucose levels. In addition to increased excretion SGLT2 inhibitors also act by increasing insulin sensitivity and increase glucose uptake in muscle cells. It further decrease gluconeogenesis. The advantages of SGLT2 include weight reduction, low incidence of hypogly-cemic episodes and reduction in blood pressure levels. While it is usually well tolerated it may increase the propen-sity to develop urinary tract infections by virtue of increasing glucose excretion. Another major side effect associ-ated with the use of this class of drugs is lactic acidosis. Taking into consideration pros and cons SGLT2 inhibitors appears to be a promising new treatment for patients of Type II diabetes mellitus in whom first and second line drugs are not working or are contraindicated for some reason.

Keywords: Type 2 diabetes mellitus, SGLT2 inhibitors, Lactic acidosis, Urinary tract Infections.