Assessing a New Class of Type 2 Drugs

SGLT2 inhibitors work by directing glucose from the kidneys into the urinary stream

| Jan 30, 2014

The name alone is a mouthful. Sodium-glucose cotransporter-2 inhibitors are one of the newest class of drugs meant to treat type 2 diabetes, but you can be forgiven if the name doesn't trip lightly off your tongue. The conspicuously vowel-free abbreviation--SGLT2--isn't much better.

You might have already heard of the first SGLT2 drug approved by the FDA. It's called Invokana, and it arrived in the United States last year. Terminology aside, this class of drugs seems to represent a conspicuous advance in treatment for type 2s. And it's all because they work in a distinctly different way than previous medications.

Most discussions of diabetes, after all, focus on insulin. If you don't make enough insulin, if you're insulin resistant, you have a problem that needs addressing. Often, the solution is either taking insulin directly or adding medication that boosts insulin production or sensitivity. The entire universe of pharmaceutical treatments focuses on insulin.

But not SGLT2 inhibitors.

These drugs make the presence felt in the kidneys, where they prevent glucose--or sugar--from being reabsorbed into the body. Instead, the extra sugar is eliminated through the patient's urine. That's certainly a different treatment mechanism than people with type 2 are used to.

But SGLT2s work. A paper going over pretrial and clinical data of the drugs (several other formulations beside Invokana were included) shows that they all of the good stuff you'd hope for from a class of diabetes drugs. Mainly, they reduces patients' A1cs and blood glucose levels. That means that the glucose being excreted in the urine isn't staying around in patients' bodies to do damage.

The drugs also seem to reduce blood pressure and weight, both of which are great for overall health, as well as cutting risks for low blood sugars. There's also a suggestion that SGLT2 drugs can improve insulin sensitivity and improve beta cell function.

And as a salesman might say, that's not all. The drug class also has promise precisely because it doesn't deal directly with the insulin side of things. That means Invokana, and the other such drugs that are bound to follow it, can be combined with earlier classes of diabetes medication with fewer problems.

But here's the part a salesman might leave out--or at least mutter under his breath while looking away from you. The class of drugs does have a possible side effect, and it's connected with the fundamental way that they work. Remember that glucose that patients are now eliminating in their urine? Sugar provides a good environment for bacterial growth, which means users might be at greater risk for genitourinary infections.

Research on the subject will no doubt continue. And as the drugs are used by more people over a longer span of time, new questions and concerns may arise. But for now, the addition of a novel treatment for type 2 diabetics is a great piece of news.

As always, if you want to make any changes to your diabetes treatment program, talk with your health care team. And if you've had experience with Invokana, let us know in the comments below. How has it worked for you?



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Categories: Genitourinary Infections, Invokana, SGLT2 Inhibitors

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