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J Clin Endocrinol Metab. 2010 Jan;95(1):34-42. doi: 10.1210/jc.2009-0473. Epub 2009 Nov 5.

Sodium glucose cotransporter 2 inhibitors as a new treatment for diabetes mellitus.

Author information

  • 1Diabetes and Endocrinology Research Unit, Clinical Sciences Centre, University Hospital Aintree, Longmoore Lane, Liverpool L9 7AL, United Kingdom.

Abstract

CONTEXT:

Sodium-glucose cotransporter 2 (SGLT2) expressed in the proximal renal tubules accounts for about 90% of the reabsorption of glucose from tubular fluid. Genetic defects of SGLT2 result in a benign familial renal glucosuria. Pharmacological agents that block SGLT2 are being tested as potential treatment for type 2 diabetes mellitus.

EVIDENCE ACQUISITION:

A Pubmed search was used to identify all relevant articles on the physiology of SGLTs as well as published preclinical and clinical experimental studies with SGLT2 inhibitors; a reference search of all retrieved articles was also undertaken.

EVIDENCE SYNTHESIS:

SGLT2 is almost exclusively expressed in the proximal renal tubules. Preclinical studies with selective SLGT2 inhibitors show dose-dependent glucosuria and lowering of blood glucose in models of type 2 diabetes. Preliminary clinical studies of up to 3-month duration show dose-dependent lowering of glycosylated hemoglobin up to 0.9% along with modest weight loss. Side effects include an increase in genital fungal infection compared to placebo, increased urine volume (300-400 ml/24 h), and evidence of volume depletion consistent with mild diuretic effect.

CONCLUSION:

SGLT2 inhibitors are showing promise as a useful addition to the current therapeutic options in type 2 diabetes mellitus. Results of ongoing phase III clinical trials are awaited and will determine whether the risk-benefit ratio will allow approval of this new class of drug for the management of type 2 diabetes mellitus.

PMID:
19892839
[PubMed - indexed for MEDLINE]
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