Sodium-Glucose Cotransporter Inhibitors ( SGLT2 )

Novel antidiabetes agents which work by increasing the urinary glucose excretion due to suppression of glucose reabsorption at the proximal convoluted tubule in the kidneys. Available agents in UK are canagliflazocin , dapagliflazocin , empagliflazocin and ertugliflazocin.

Humans filter 160-180 glucose / day which is reabsorbed and returned to systemic circulation SGLTs are sodium glucose transporters on the luminal membrane of the proximal tubule Diabetes is associated with glomerular hyperfiltration and upregulation of SGLT2 expression -increased Sodium glucose transporter 2 ( SGLT2 ) proteins in the proximal convoluted tubules of the kidneys account for about 90 % of filtered glucose reabsorption ( 6 identified SGLTS - SGLT1 & 2 are considered most important ) In type 2 diabetes patients -renal threshold ( normally 180 mg / dL ) for reabsorption of glucose is increased and this worsens hyperglycemia -using SGLT2 inhibitors this threshold can be reduced to 40-120 mg / dL SGLT2 inhibitors reduce glucose reabsorption by 50 % to 60 % Hence use of SGLT2 inhibitors causes glycosuria of about 60-80 g/ day which is about 240-320 kcal energy loss As glucose is excreted - level in plasma falls leading to an improvement in all glycemic parameters Lower systemic...