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Moulton MK, Johnson BR, Lavender DL, Osae SP, Phillips BB, Thomas I, Stone RH. A Scoping Review Evaluating the Effect of SGLT-2 Inhibitors on Insulin Dose Requirements in Insulin-Dependent Patients With Type 2 Diabetes. Ann Pharmacother 2022; 56:1030-1040. [PMID: 35040335 DOI: 10.1177/10600280211071089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Assess evidence describing the effect of Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors on total daily insulin (TDI) requirements in insulin-dependent patients with type 2 diabetes. DATA SOURCES A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols and Scoping Reviews (PRISMA-ScR) guidelines. The search was conducted in PubMed; citation mapping was completed in Web of Science. Filters for human studies, English language, and a publication date, from January 1, 2005 to April 12, 2021, were applied. STUDY SELECTION AND DATA EXTRACTION Studies assessing insulin dose requirements with concurrent use of an SGLT2 inhibitor for patients with type 2 diabetes were included. DATA SYNTHESIS Sixteen studies were included and demonstrated that addition of an SGLT2 inhibitor typically reduced TDI requirements. Insulin reductions were often statistically significant, occurring in studies evaluating (1) within subjects who received SGLT2 inhibitors, and (2) between subjects receiving SGLT2 inhibitors versus placebo. Compared with placebo, insulin dose reduction ranged from -0.72 to -19.2 units. However, studies were relatively small, not designed to assess TDI change, and some utilized fixed dose insulin protocols or empiric insulin dose reductions. CONCLUSIONS Lowering insulin requirements may have benefits, such as decreased hypoglycemia risk, insulin resistance, and cost. Addition of an SGLT2 inhibitor may modestly reduce TDI requirements for patients with type 2 diabetes. Evidence indicating SGLT2 inhibitor use reduces TDI may lead to additional implementation in practice and inform future research. Further research is needed to clarify insulin type (i.e., basal or prandial) and degree of TDI reduction expected with addition of an SGLT2 inhibitor.
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Affiliation(s)
- Morgan K Moulton
- Central Alabama Veterans Health Care System, U.S. Department of Veterans Affairs, Montgomery, AL, USA
| | - Blake R Johnson
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Georgia, Athens, GA, USA
| | - Devin L Lavender
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Georgia, Athens, GA, USA
| | - Sharmon P Osae
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Georgia, Athens, GA, USA
| | - Beth Bryles Phillips
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Georgia, Athens, GA, USA
| | - Ian Thomas
- UGA Libraries, The University of Georgia, Athens, GA, USA
| | - Rebecca H Stone
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Georgia, Athens, GA, USA
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Joaqui VB, Gómez NB, Ortiz RC, Toro LMO, Lombo JPM, Cifuentes CAS, García MAM, Lomba AA. Effectiveness of triple therapy with dapagliflozin add-on to dual therapy over 52 weeks in patients with uncontrolled type 2 diabetes mellitus in a centre of high complexity, Cali-Colombia. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:49-59. [PMID: 33444492 PMCID: PMC10528692 DOI: 10.20945/2359-3997000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/27/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of adding dapagliflozin as an intensification strategy for the treatment of patients with uncontrolled type 2 diabetes mellitus (T2DM). METHODS A historical cohort study was conducted in 123 adult patients over 18 years old who were diagnosed with uncontrolled T2DM, who received dapagliflozin add-on to their dual base treatment: metformin plus glibenclamide (n = 32), metformin plus saxagliptin (n = 29), metformin plus exenatide (n = 28), or metformin plus insulin (n = 34). The endpoints were evaluated using analysis of variance. RESULTS All the patients completed a 52-week follow-up. Overall, 52.85% of patients were female, the Hispanic population represented the largest proportion of patients in all groups (60.98%), and the mean ± SD patient age and body weight were 55.05 ± 7.58 years and 83.55 ± 9.65 kg, respectively. The mean ± SD duration of T2DM, glycated hemoglobin (HbA1c), and fasting plasma glucose (FPG) were 5.93 ± 2.98 years, 8.1 ± 0.53%, and 166.03 ± 26.80 mg/dL, respectively. The grand mean changes of HbA1c, FPG, body weight and blood pressure showed a decreasing trend during the study period and it was statistically significant in all groups (p-value = <0.001). The proportion of patients achieving HbA1c target (<7%) was highest in the group that used a dapagliflozin add-on to metformin plus saxagliptin. CONCLUSION The addition of dapagliflozin as an alternative for intensification of dual therapy consistently improved, not only FPG and HbA1c, but also body weight and blood pressure, with statistically significant results.
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Affiliation(s)
- Vanessa Bedoya Joaqui
- Departamento de Medicina Interna, GIMI1 (Grupo Interinstitucional de Medicina Interna 1), Universidad Libre, Cali, Colombia
| | - Nathalia Buitrago Gómez
- Departamento de Medicina Interna, GIMI1 (Grupo Interinstitucional de Medicina Interna 1), Universidad Libre, Cali, Colombia
| | - Reinaldo Carvajal Ortiz
- Centro Médico Imbanaco S.A., Cali, Colombia; Departamento de Medicina Interna, GIMI1 (Grupo Interinstitucional de Medicina Interna 1), Universidad Libre, Cali, Colombia
| | | | - Jenny Patricia Muñoz Lombo
- Departamento de Medicina Interna, GIMI1 (Grupo Interinstitucional de Medicina Interna 1), Universidad Libre, Cali, Colombia
| | | | | | - Alín Abreu Lomba
- Centro Médico Imbanaco S.A., Cali, Colombia; Departamento de Medicina Interna, GIMI1 (Grupo Interinstitucional de Medicina Interna 1), Universidad Libre, Cali, Colombia,
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Das B, Sheikh A, Ahmed B, Islam N. Clinical outcomes of Sodium-glucose cotransporter-2 inhibitors in patients with Type 2 Diabetes Mellitus: An observational study from Pakistan. Pak J Med Sci 2021; 37:1342-1346. [PMID: 34475909 PMCID: PMC8377933 DOI: 10.12669/pjms.37.5.3901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/04/2020] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine the efficacy and safety of Sodium-glucose cotransporter-2 inhibitors (SGLT2i) use in the Pakistani population. Methods: Retrospective review of initial 100 patients who were prescribed with any agent of the SGLT2i group from July 1, 2018, to January 2019 at Aga Khan University Hospital, Karachi. SGLT2i was offered to patients of above 18 years of age with inadequate glycemic control on existing antidiabetic agents. Changes in HbA1c, the Body Mass Index (BMI), serum creatinine, any decrease in the requirement of insulin and sulphonylurea dose along with any side effects reported by the patients on follow-up visits. Results: Most study participants were females (56%) with the mean age of 52±10 years. Substantial changes were observed in the HbA1c (7.5±1.1%, 7.9±1.2% from 8.7±1.5%, p < 0.01), BMI (31.4±5.8, 31.8±5.8 from 32.4±5.9kg/m2, p < 0.01) and in creatinine (0.71±0.1, 0.75±0.1 from 0.79±0.1 mg/dl, p < 0.01) at three and six months of follow up visits. The reduction in insulin and sulphonylurea doses was also significant. Adverse drug events that led to drug discontinuation in 14 individuals were, Urinary tract infection (UTI) (seven patients), Genital infection (three patients), nausea +UTI, abdominal pain +UTI, mild Diabetic Ketoacidosis, and polyuria (one patient each). None reported Fournier’s gangrene, limb amputation, or fracture. Conclusion: SGLT2i significantly improved glycemic control, BMI, and serum creatinine in the Pakistani population with a very low number of observed adverse events.
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Affiliation(s)
- Bhagwan Das
- Bhagwan Das, FCPS. Department of Medicine, Section of Endocrinology, Aga Khan University, Karachi, Pakistan
| | - Aisha Sheikh
- Aisha Sheikh, FCPS. Department of Medicine, Section of Endocrinology, Aga Khan University, Karachi, Pakistan
| | - Bilal Ahmed
- Bilal Ahmed, PhD. Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Najmul Islam
- Najmul Islam, FRCP. Department of Medicine, Section of Endocrinology, Aga Khan University, Karachi, Pakistan
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Estrada AK, Delgado-Maldonado T, Lara-Ramírez EE, Martínez-Vázquez AV, Ortiz-Lopez E, Paz-González AD, Bandyopadhyay D, Rivera G. Recent Advances in the Development of Type 2 Sodium-Glucose Cotransporter Inhibitors for the Treatment of Type 2 Diabetes Mellitus. Mini Rev Med Chem 2021; 22:586-599. [PMID: 34353256 DOI: 10.2174/1389557521666210805112416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is one of the most serious and prevalent diseases worldwide. In the last decade, type 2 sodium-glucose cotransporter inhibitors (iSGLT2) were approved as alternative drugs for the pharmacological treatment of T2DM. The anti-hyperglycemic mechanism of action of these drugs involves glycosuria. In addition, SGLT2 inhibitors cause beneficial effects such as weight loss, a decrease in blood pressure, and others. OBJECTIVE This review aimed to describe the origin of SGLT2 inhibitors and analyze their recent development in preclinical and clinical trials. RESULTS In 2013, the FDA approved SGLT2 inhibitors as a new alternative for the treatment of T2DM. These drugs have shown good tolerance with few adverse effects in clinical trials. Additionally, new potential anti-T2DM agents based on iSGLT2 (O-, C-, and N-glucosides) have exhibited a favorable profile in preclinical evaluations, making them candidates for advanced clinical trials. CONCLUSION The clinical results of SGLT2 inhibitors show the importance of this drug class as new anti-T2DM agents with a potential dual effect. Additionally, the preclinical results of SGLT2 inhibitors favor the design and development of more selective new agents. However, several adverse effects could be a potential risk for patients.
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Affiliation(s)
- Ana Karen Estrada
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
| | - Timoteo Delgado-Maldonado
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
| | - Edgar E Lara-Ramírez
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social (IMSS), 98000 Zacatecas. Mexico
| | - Ana Verónica Martínez-Vázquez
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
| | - Eyra Ortiz-Lopez
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
| | - Alma D Paz-González
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
| | | | - Gildardo Rivera
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
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Sohail E, Ahsan T, Ghaus S, Aijaz W. SGLT 2 Inhibitors; glycemic control, weight loss and safety profile in patients with type 2 Diabetes, at Medicell Institute (MIDEM). Pak J Med Sci 2020; 37:87-92. [PMID: 33437256 PMCID: PMC7794133 DOI: 10.12669/pjms.37.1.2701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background & Objective: Sodium glucose co-transporter-2 inhibitors (SGLT 2 inhibitors) are newer anti-hyperglycemic agents, which improve glycemic control independent of insulin secretion with a low risk of hypoglycemia. This study aimed to assess the efficacy of SGLT 2 inhibitors in terms of glycemic control, weight reduction and safety profile in our patients with type 2 Diabetes (T2D). Methods: This is a prospective analysis, conducted at Medicell Institute of Diabetes, Endocrinology and Metabolism (MIDEM), Karachi Pakistan from January 2018 till July 2019. This study included patients with T2D, who were treated with SGLT 2 inhibitors add on to other anti-diabetic drugs. Baseline and follow up weight, BMI, HbA1c, blood pressure (BP), renal function and side effect profile was assessed. Results: Study included 140 patients; 53% females and 47% males. Mean Age was 55.6 ± 10.3 years. Mean weight at baseline was 81.5 ±16.5 kg. Mean duration of T2D was 10.3 ± 6.75 years, with a mean HbA1C at baseline of 9.1± 1.6%. Follow up data was available for 90 patients at the time of analysis. HbA1C improved considerably to 7.6± 0.9 (P< 0.001) and mean weight reduced to 78.5 ± 16.1 kg (P≤0.003), at first follow-up. Conclusion: Dapagliflozin and Empagliflozin offer a significant additional drug in improving glycemic control with the additional advantage of weight loss and hypoglycemia safety.
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Affiliation(s)
- Erum Sohail
- Dr. Erum Sohail, FCPS, MBBS. Medicell Institute of Diabetes Endocrinology & Metabolism (MIDEM), 9E, 8Zamzama Commercial Lane, Phase-V, DHA, Karachi, Pakistan
| | - Tasnim Ahsan
- Prof. Tasnim Ahsan, MRCP(UK), FRCP(Glasg), FRCP(Edin), FRCP(Lon). Medicell Institute of Diabetes Endocrinology & Metabolism (MIDEM), 9E, 8Zamzama Commercial Lane, Phase-V, DHA, Karachi, Pakistan
| | - Saima Ghaus
- Dr. Saima Ghaus, FCPS, MBBS. Medicell Institute of Diabetes Endocrinology & Metabolism (MIDEM), 9E, 8Zamzama Commercial Lane, Phase-V, DHA, Karachi, Pakistan
| | - Wasfa Aijaz
- Dr. Wasfa Aijaz, FCPS, MBBS. Medicell Institute of Diabetes Endocrinology & Metabolism (MIDEM), 9E, 8Zamzama Commercial Lane, Phase-V, DHA, Karachi, Pakistan
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