New Oral Hypoglycemic Agents and Cardiovascular Risk. Crossing the Metabolic Border.
Sodium-glucose cotransporter 2 inhibitors are a novel pharmacological class of oral hypoglycemic agents that lower glucose levels by increasing renal glucose excretion in an insulin-independent manner. However, this seemingly simple mechanism has more complex indirect metabolic effects. The results of randomized clinical trials have shown that these inhibitors effectively lower blood glucose and glycated hemoglobin levels without increasing the risk of hypoglycemia and, at the same time, also reduce bodyweight and systolic blood pressure. In this review, we describe the mechanism of action, efficacy, and safety of currently marketed drugs, as well as other risk factors besides glucose that can potentially be modulated positively. Recent data on empagliflozin showing a significant cardiovascular benefit have compelled us to update knowledge of this new therapeutic class for the treatment of type 2 diabetes.
Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Electronic address: bdalama@vhebron.net.
Belén
B
Dalama
Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Jordi
J
Mesa
D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D001835:Body Weight; D000068896:Canagliflozin / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000378:metabolism / Q000503:physiopathology; D008076:Cholesterol, HDL / Q000378:metabolism; D008078:Cholesterol, LDL / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D005960:Glucosides / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D011507:Proteinuria; D012306:Risk; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D016896:Treatment Outcome; D014527:Uric Acid / Q000378:metabolism; D059289:Vascular Stiffness
D001559:Benzhydryl Compounds; D001786:Blood Glucose; D000068896:Canagliflozin; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D005960:Glucosides; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D014527:Uric Acid; C517652:hemoglobin A1c protein, human; C529054:dapagliflozin; C570240:empagliflozin
Cardiovascular disease; Diabetes mellitus tipo 2; Enfermedad cardiovascular; Inhibidor del cotransportador de sodio–glucosa tipo 2; Sodium-glucose cotransporter 2 inhibitor; Type 2 diabetes mellitus