Sodium-glucose cotransporter 2 inhibition and health benefits: The Robin Hood effect

Kalra, Sanjay; Jain, Arpit; Ved, Jignesh; Unnikrishnan, AG

doi:10.4103/2230-8210.183826

Cited by 37 publications

(29 citation statements)

References 35 publications

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“…Based on the metabolic status, individuals can be categorized into three types. [4647] The healthy individuals, considered to be “eubolic,” with appropriate balance between catabolism and anabolism have a normal IGR. Persons with hyperinsulinemia (insulin resistance) have a high IGR and can be termed “maladaptively anabolic.” In such patients, overweight or obesity, high BP, dyslipidemia, and insulin resistance are observed.…”

Section: Sodium–glucose Co-transportersmentioning

confidence: 99%

“…A fall in IGR due to increase in glucagon and reduction in insulin levels is observed with SGLT2i treatment. [4647] For maladaptive anabolism, therefore, SGLT2i are the preferred choice of treatment. However, SGLT2i can also be used in “eubolic” patients.…”

Section: Sodium–glucose Co-transportersmentioning

confidence: 99%

“…[46] In tandem with this mechanism, the lowered IGR and pro-ketogenic effect of SGLT2i shift the focus from the strained carbohydrate utilization mechanism to the underused accumulated bounty of lipids. [313246484950] This state may be considered a beneficial action that can rectify the “maladaptive anabolism” observed in obese T2DM patients.…”

Section: Sodium–glucose Co-transportersmentioning

confidence: 99%

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

Kalra

Ghosh

Aamir

et al. 2017

Indian J Endocr Metab

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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.

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Section: Sodium–glucose Co-transportersmentioning

confidence: 99%

Section: Sodium–glucose Co-transportersmentioning

confidence: 99%

Section: Sodium–glucose Co-transportersmentioning

confidence: 99%

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

Kalra

Ghosh

Aamir

et al. 2017

Indian J Endocr Metab

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“…Essentially, the SGLT2 inhibited state is akin to a modest carbohydrate-restricted mimetic. Noteworthy, the SGLT2 inhibited state has also been discussed in the context of a ketogenic diet [49,50] and our current and previous data demonstrate greater reliance on fat oxidation at rest and during exercise [24]. We surmised that low carbohydrate absorption may be "sensed" and eventually lead to adaptation manifested as changes in eating behavior.…”

Section: Discussionmentioning

confidence: 58%

Sodium Glucose Co-Transporter 2 Inhibition Does Not Favorably Modify the Physiological Responses to Dietary Counselling in Diabetes-Free, Sedentary Overweight and Obese Adult Humans

et al. 2020

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Sedentary obesity is associated with increased risk of many cardio-metabolic diseases, including type 2 diabetes. Weight loss is therefore a desirable goal for sedentary adults with obesity. Weight loss is also a well-documented side effect of sodium glucose co-transporter 2 (SGLT2) inhibition, a pharmaceutical strategy for diabetes treatment. We hypothesized that, compared with placebo, SGLT2 inhibition as an adjunct to out-patient dietary counselling for weight loss would lead to more favorable modification of body mass and composition, and greater improvement in glucose regulation and lipid profile. Using a randomized, double-blind, repeated measures parallel design, 50 sedentary men and women (body mass index: 33.4 ± 4.7 kg/m2; mean ± SD) were assigned to 12 weeks of dietary counselling, supplemented with daily ingestion of either a placebo or SGLT2 inhibitor (dapagliflozin: up to 10 mg/day). Dietary counselling favorably modified body mass, body fat, glucose regulation, and fasting concentrations of triglyceride and very low-density lipoprotein cholesterol (main effects of counselling: p < 0.05); SGLT2 inhibition did not influence any of these adaptations (counselling × medication interactions: p > 0.05). However, SGLT2 inhibition when combined with dietary counselling led to greater loss of fat-free mass (counselling × medication interaction: p = 0.047) and attenuated the rise in high-density lipoprotein cholesterol (counselling × medication interaction: p = 0.028). In light of these data and the health implications of decreased fat-free mass, we recommend careful consideration before implementing SGLT2 inhibition as an adjunct to dietary counselling for weight loss in sedentary adults with obesity.

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“…A dapa-, cana-és empagliflozinnal végzett fázis 2. és 3. vizsgálatok metaanalízisei során a kardiovaszkuláris rizikó csökkenésére gyakorolt hatások igencsak eltérő mértéke további óvatosságra int a vélt csoporthatás megítélésében. 27,29 Megemlítendő, hogy a minor amputációkkal kapcsolatos felhívást a hatóság az alkalmazási előírások között a canagliflozinra tekintettel írta elő, ami az SGLT-2-gátlók indikálása és alkalmazása esetén rendszeres lábvizsgálatot és korrekt betegtájékoztatást jelent.…”

Section: áBra Az Sglt-2-gátlók Előnyös Szív-érrendszeri Hatásainak Lunclassified

A 2-es típusú cukorbetegek személyre szabott kezelése: fókuszban a korai SGLT2-gátló terápia

Balogh¹,

Sira²

2017

Diabetologia Hungarica

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Közismert, hogy a 2-es típusú diabeteses betegek kardiovaszkuláris morbiditása és mortalitása 2-4-szerese az egészséges egyénekének, különösen a szívinfarktus, szívelégtelenség és az ischaemiás stroke gyakoribb. Napjainkban a metformin tekinthető a 2-es típusú cukorbetegek első vonalbeli optimális gyógyszeres kezelésének az igazoltan kifejezett glykaemiás hatás, a kedvező biztonságossági profil, az alacsony kezelési költség és a kardiovaszkuláris eseményekre gyakorolt jótékony hatása miatt. Az újabb antihyperglykaemiás szerek közé tartozó SGLT-2-gátlók a vesék proximalis tubulusaiban gátolják a glukóz visszaszívódását, az így elért kifejezett glucosuria a HbA 1c , az éhomi és a postprandialis vércukorértéket egyaránt csökkenti, mindezt az endogén inzulintermeléstől függetlenül. Nemrégen az EMPA-REG OUTCOME vizsgálat dokumentáltan magas kardiovaszkuláris rizikójú 2-es típusú cukorbetegek körében igazolta a standard antidiabetikus kezeléshez adott empagliflozinnak a kardiovaszkuláris végpontokra kifejtett előnyös hatását. A jelen közleményben az SGLT-2-gátlóknak a kardiovaszkuláris eseményekre gyakorolt hatásait tekintik át a szerzők az irodalmi adatok alapján. ■ Kulcsszavak: nátrium-glukóz kotranszporter-2 gátlók, kardiovaszkuláris hatások, a mindennapi klinikai gyakorlat adatai Individualized management of patients with type 2 diabetes: focus on early SGLT2-inhibitor therapy Summary: It is well known that patients with type 2 diabetes have 2 to 4 times increased risk of cardiovascular morbidity and mortality than healthy individuals, namely myocardial infarction, heart failure, and ischemic stroke. Nowadays, metformin remains the optimal first-line treatment choice for the management of type 2 diabetic patients, given its wellestablished glycemic efficacy and safety profile, low treatment cost, and its beneficial impact on cardiovascular endpoints. Novel glucose-lowering agents, such as SGLT-2 inhibitors reduce glucose reabsorption in the renal proximal tubules and increases renal glucose excretion via the urine leading to reduced HbA 1c , fasting and postprandial plasma glucose levels, independently from endogenous insulin secretion. The EMPA-REG OUTCOME study has recently shown that empagliflozin, when added to the standard of care treatment, reduced the risk of cardiovascular endpoints in patients with type 2 diabetes who were also at high cardiovascular risk. In this review we summarize the data on the impact on SGLT2 inhibitors on the risk of cardiovascular events.

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Sodium-glucose cotransporter 2 inhibition and health benefits: The Robin Hood effect

Cited by 37 publications

References 35 publications

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

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

Sodium Glucose Co-Transporter 2 Inhibition Does Not Favorably Modify the Physiological Responses to Dietary Counselling in Diabetes-Free, Sedentary Overweight and Obese Adult Humans

A 2-es típusú cukorbetegek személyre szabott kezelése: fókuszban a korai SGLT2-gátló terápia

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