Differential cardiovascular profiles of sodium-glucose cotransporter 2 inhibitors: critical evaluation of empagliflozin

Sanon, Vani P.; Patel, Shalin V.; Sanon, Saurabh; Rodríguez, Rubén; Pham, Son V.; Chilton, Robert

doi:10.2147/tcrm.s97619

Cited by 5 publications

(5 citation statements)

References 48 publications

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“…A recent study comparing trial against real world data concluded that extrapolation of the trials and the results in the real world do not match [ 2 ]. Further research is needed to clarify and validate the benefits of SGLT2 at the translational biology level as well as its impact on clinical medicine [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

SGLT2 inhibitors as add on therapy in type 2 diabetes: a real world study

Tamez-Pérez

Delgadillo-Esteban

Soni-Duque³

et al. 2017

J Diabetes Metab Disord

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BackgroundType 2 diabetes mellitus (T2DM) is a progressive chronic disease associated with severe microvascular and macrovascular complications.Our aim is to assess the real world effectiveness of SGT" inhibitors in achieving metabolic therapeutic goals.MethodsA retrospective, observational study. Inclusion criteria for patients were a previous diagnosis of type 2 diabetes mellitus, age > 18 years, patients receiving either dapagliflozin 10 mg and/or canagliflozin 300 mg. We excluded pregnant patients, patients with type 1 diabetes mellitus and acute metabolic complications of diabetes. Patients included in the analysis were enrolled in a health plan at least 6 months prior to the index date (baseline period) and in the 6 months following the index date (follow-up period). Achievement of glycated hemoglobin goals were established as <7%.ResultsWe screened 2870 Mexican patients; 288 (10.03% received SGLT2 inhibitors). Mean age for both groups of patients was 57.68 ± 11.06 years. The dapagliflozin control rate was 19.56% and the canagliflozin control rate 18.96%. Monotherapy with SGLT2 inhibitors was used in 21 patients (6.25%). Overall HbA1c goals were met in 56 patients (19.44%) with similar results with dapagliflozin or canagliflozin. The combination of SGLT2 inhibitors and sulfonylureas had the highest control rate (30.30%) compared to other regimens. Monotherapy was present in 6.25%. Insulin requirement was associated with poor control (2.8% vs. 18.05%, P < 0.05, 95% CI [0.07, 0.84]). Combination therapy with DPP4 inhibitors was associated with better control (P < 0.05, 95% CI, [1.10, 3.92]).ConclusionNo difference between the drugs was observed. Real-world effectiveness data of SGLT2 inhibitors show that the percentage of patients reaching metabolic goals is low. SLGT2 inhibitors were used more frequently as combined therapy.

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Section: Discussionmentioning

confidence: 99%

SGLT2 inhibitors as add on therapy in type 2 diabetes: a real world study

Tamez-Pérez

Delgadillo-Esteban

Soni-Duque³

et al. 2017

J Diabetes Metab Disord

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“…In T2DM patients with CVD and peripheral vascular disease, we suggest the use of GLP1-RA as the data from LEADER and SUSTAIN-6 did not show any evidence of increased risk of amputation, unlike canagliflozin, which showed an almost double the risk of lower limb amputation [15–17]. Fortunately, this risk has not been proved in any other studies of the SGLT2i including the DECLARE- TIMI 58 trial [28].…”

Section: Consensus Recommendations For the Management Of T2dm In Patimentioning

confidence: 99%

Consensus recommendations for management of patients with type 2 diabetes mellitus and cardiovascular diseases

Bashier

Hussain

Abdelgadir

et al. 2019

Diabetol Metab Syndr

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The recent American Diabetes Association and the European Association for the Study of Diabetes guideline mentioned glycaemia management in type 2 diabetes mellitus (T2DM) patients with cardiovascular diseases (CVDs); however, it did not cover the treatment approaches for patients with T2DM having a high risk of CVD, and treatment and screening approaches for CVDs in patients with concomitant T2DM. This consensus guideline undertakes the data obtained from all the cardiovascular outcome trials (CVOTs) to propose approaches for the T2DM management in presence of CV comorbidities. For patients at high risk of CVD, metformin is the drug of choice to manage the T2DM to achieve a patient specific HbA1c target. In case of established CVD, a combination of glucagon-like peptide-1 receptor agonist with proven CV benefits is recommended along with metformin, while for chronic kidney disease or heart failure, a sodium–glucose transporter proteins-2 inhibitor with proven benefit is advised. This document also summarises various screening and investigational approaches for the major CV events with their accuracy and specificity along with the treatment guidance to assist the healthcare professionals in selecting the best management strategies for every individual. Since lifestyle modification and management plays an important role in maintaining the effectiveness of the pharmacological therapies, authors of this consensus recommendation have also briefed on the patient-centric non-pharmacological management of T2DM and CVD.

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“…A recent study noted that the number needed to treat (NNT) to see a benefit in all-cause death compared favourably for empagliflozin against simvastatin or ramipril [103]. When published data for CV death, HHF and all-cause mortality were examined in a non-head-to-head illustrative comparison, SGLT2i therapies have favourable HF reductions compared with angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), with each drug compared to placebo (Fig.…”

Section: Overcoming Treatment Comfort In Type 2 Diabetes Management: mentioning

confidence: 99%

“…SGLT2i treatments are well tolerated and have a favourable risk–benefit profile for many people with T2DM [1]. In practice, SGLT2i therapies appear to have a meaningful impact, with an NNT for several CVD outcomes similar to those of commonly prescribed drugs for the management and prevention of CVD [103].…”

Section: Maximising Benefits In the Treatment Of Type 2 Diabetes: Beymentioning

confidence: 99%

SGLT2 Inhibitors: Cardiovascular Benefits Beyond HbA1c—Translating Evidence into Practice

Amar¹,

Baín

Hicks

et al. 2019

Diabetes Ther

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Cardiovascular disease (CVD), including heart failure (HF), is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus (T2DM). CVD and T2DM share common risk factors for development and progression, and there is significant overlap between the conditions in terms of worsening outcomes. In assessing the cardiovascular (CV) safety profiles of anti-diabetic drugs, sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapies have emerged with robust evidence for reducing the risk of adverse CVD outcomes in people with T2DM who have either established CVD or are at risk of developing CVD. A previous consensus document from the Improving Diabetes Steering Committee has examined the potential role of SGLT2is in T2DM management and considered the risk-benefit profile of the class and the appropriate place for these medicines within the T2DM pathway. This paper builds on these findings and presents practical guidance for maximising the pleiotropic benefits of this class of medicines in people with T2DM in terms of Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.8276270.

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Differential cardiovascular profiles of sodium-glucose cotransporter 2 inhibitors: critical evaluation of empagliflozin

Cited by 5 publications

References 48 publications

SGLT2 inhibitors as add on therapy in type 2 diabetes: a real world study

SGLT2 inhibitors as add on therapy in type 2 diabetes: a real world study

Consensus recommendations for management of patients with type 2 diabetes mellitus and cardiovascular diseases

SGLT2 Inhibitors: Cardiovascular Benefits Beyond HbA1c—Translating Evidence into Practice

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