Currently, about 29 million Americans have diabetes according to the CDC. Despite evidence that optimal glycemic control can help reduce disease progression and complications, most patients do not achieve recommended treatment goals.
“Effective management of type 2 diabetes mellitus (T2DM) requires the use of combination therapy with different mechanisms of action,” said Germin Fahim, PharmD, BCPS, Clinical Assistant Professor at Ernest Mario School of Pharmacy and internal medicine clinical pharmacist at Monmouth Medical Center, Long Branch, N.J. The world of diabetes is rapidly evolving, and staying abreast of various treatment options enables pharmacists to provide optimal patient care.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors, unlike other available agents, decrease renal glucose reabsorption by promoting urinary glucose excretion. “This novel mechanism of action offers clinicians a different approach to individualize diabetes treatment and help patients control their blood sugar levels,” said Fahim.
The class is currently made up of 3 agents—canagliflozin (Invokana, Janssen), dapagliflozin (Farxiga, AstraZeneca), and empagliflozin (Jardiance, Boehringer Ingelheim). Fahim pointed out that additional benefits of using SGLT2 inhibitors in individuals with T2DM include significant reductions in blood pressure and body weight.
Regulatory guidance specifies the need to establish cardiovascular (CV) safety of new diabetes therapies to rule out excess CV risk. According to a study published in the New England Journal of Medicine – involving more than 7,000 patients with T2DM – those receiving empagliflozin had significantly lower rates of death from CV events, hospitalization for heart failure, and death from any cause compared with placebo.1 As reported in previous clinical trials, genital infection was more common in the empagliflozin group than placebo.
Fahim views glucagon-like-peptide-1 (GLP-1) receptor agonists as a welcome addition to the diabetes therapy armamentarium, because they effectively lower A1C, weight, and blood pressure while posing a low risk of hypoglycemia.