In this CME offering presented by the Primary Care Network and Diabetes Series Live, Drs. Richard Beaser, Associate Professor of Medicine and Harvard Medical School and Nuha El Sayed, Director of International Programs at Joslin Diabetes Center introduce and educate viewers on a relatively new class of drugs to combat Type II Diabetes; the SGLT-2 inhibitors.
Discussions include the SGLT-2 physiology as it relates to the kidney and how it can be targeted as part of the treatment of hyperglycemia in type 2 diabetes, demonstration of the possible integration of SGLT-2 inhibitors into a comprehensive glycemic treatment program from type 2 diabetes, and extensive time is spent identifying the risks and benefits of SGLT02 inhibitors to optimize their safety and efficacy.
Dr. El Sayed talks about the “Ominous Octet” as it relates to hyperglycemia, and indicates increased glucose reabsorption by the kidneys is a major contributor to increased weight, renal impairment and hypertension in many patients who use traditional medications for type 2 diabetes. The use of SGLT-2 inhibitors in conjunction with other traditional medications can help patients decrease glucose reabsorption, increase urinary glucose excretion, and providers (and patients) will be able to observe weight loss and generalized decreased blood pressures.
Dr. Beaser points out with the increase in the number of medications and varying mechanisms of action, providers can use multiple medications to treat the various aspects of type 2 diabetes rather than “banging away” at one cause with a maximum dose of a given medication.
An important factor in determining which medication or medications to use is the treatment goal. When comparing the two leading diabetes research organizations’ criteria (A1c, pre-prandial glucose levels, and 2- hour post-prandial glucose levels), each one is different enough that providers can claim success with one standard while not meeting criteria for success in the other. When discussing goals with your provider, it is important to determine if you will be following the American Association of Clinical Endocrinologists (AACE) or American Diabetes Association (ADA) guidelines for success. Dr. Beaser states that good “control is defined as both A1C average levels and glycemic patterns” over time, rather than just a few positive results.
The presenters go into depth with explanations of pharmacological interventions for diabetes, an overview on noninsulin medications for diabetes, then delve into the role of the kidney in glucose metabolism. These roles involve:
- Production; in the form of gluconeogenesis
- Utilization; the kidneys use glucose just like all of our other organs,
- Reabsorption; the re-uptake of glucose in the blood stream as it passes through the proximal tubules.
The class of medications known as SGLT2 Inhibitors act on this third role to help prevent glucose from returning to the bloodstream, thus helping to manage type 2 diabetes. SGLT2 medications have also been shown to have side benefits in patients with cardiovascular disease; something that is not associated with other traditional type 2 diabetes medications.
For more information and in-depth explanation of the medications listed here, please watch “SGLT-2 Inhibitors in the Treatment of Type 2 Diabetes: Methodology and Monitoring Impact,” presented by DIABETES SERIES LIVE.
Disclaimer: All DIABETES SERIES LIVE articles, reports, summaries, and recaps of events are for informational purposes. The quotes and opinions of the speakers covered are not to be taken as direct advice for individual patients. Patients should always seek care from qualified, properly accredited healthcare professionals.