Sodium-glucose cotransporter 2 inhibition and health benefits: The Robin Hood effect

Indian J Endocrinol Metab. 2016 Sep-Oct;20(5):725-729. doi: 10.4103/2230-8210.183826.

Abstract

This review discusses two distinct, yet related, mechanisms of sodium-glucose cotransporter 2 (SGLT2) inhibition: Calorie restriction mimicry (CRM) and pro-ketogenic effect, which may explain their cardiovascular benefits. We term these adaptive CRM and pro-ketogenic effects of SGLT2 inhibition, the Robin Hood hypothesis. In English history, Robin Hood was a "good person," who stole from the rich and helped the poor. He supported redistribution of resources as he deemed fit for the common good. In a similar fashion, SGLT2 inhibition provides respite to the overloaded glucose metabolism while utilizing lipid stores for energy production.

Keywords: Calorie restriction mimicry canagliflozin; EMPA-REG outcome; cardiovascular outcomes; dapagliflozin; diabetes; empagliflozin; ketogenesis; ketogenic diet; liraglutide.