title: Empagliflozin in the treatment of type 2 diabetes: evidence to date.
abstract: In the last decade, researchers have gained a greater understanding of the pathophysiologic mechanisms of type 2 diabetes as a chronic and progressive disease. One of the more recent treatment targets is the kidney. The kidneys become maladaptive in diabetes by increasing the reabsorption of glucose above the normal physiologic renal threshold. This discovery has led to the development of the sodium/glucose cotransporter 2 inhibitors (SGLT2). These agents readjust the renal threshold for glucose reabsorption to a lower level and decrease glucose reabsorption, while increasing urinary glucose when the glucose is above the renal threshold and subsequently lowering plasma glucose. The mechanism of action of the SGLT2 inhibitors is insulin independent, which makes them a novel treatment of diabetes. At the time of preparation of this manuscript, there were three SGLT2 inhibitors available in the US. This manuscript focuses on empagliflozin, the newest SGLT2 inhibitor, the trials in its development, and the clinical data available to date. Further, the authors propose future applications of empagliflozin, including in the treatment of type 1 diabetes, and its potential role in renoprotection.
authors.affiliation: Primary Care Department, Clinical Research and Diabetes Services, Touro University College of Osteopathic Medicine, Vallejo, CA, USA.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Shubrook
authors.affiliation: The Diabetes Institute at Ohio University, Ohio University, Athens, OH, USA.
authors.forename: Babak Baradar
authors.initials: BB
authors.lastname: Bokaie
authors.affiliation: Pharmacy Practice and Administration, College of Pharmacy, Ohio State University, Athens, OH, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Adkins
mesh_terms: D001559:Benzhydryl Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D001786:Blood Glucose / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology; D018450:Disease Progression; D005960:Glucosides / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007328:Insulin / Q000378:metabolism; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D000077203:Sodium-Glucose Transporter 2 Inhibitors
chemical_list: D001559:Benzhydryl Compounds; D001786:Blood Glucose; D005960:Glucosides; D007004:Hypoglycemic Agents; D007328:Insulin; D000077203:Sodium-Glucose Transporter 2 Inhibitors; C570240:empagliflozin
keywords: SGLT-2 inhibitors; empagliflozin; glucosuria; kidneys; type 1 diabetes; type 2 diabetes