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      SGLT2 inhibitors in the management of type 2 diabetes.

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          Abstract

          The glucose-lowering pharmacopeia continues to grow for patients with type 2 diabetes. The latest drug category, the SGLT2 inhibitors reduce glycated hemoglobin concentrations by increasing urinary excretion of glucose. They are used mainly in combination with metformin and other antihyperglycemic agents, including insulin. Their glucose-lowering potency is modest. Advantages include lack of hypoglycemia as a side effect, and mild reduction in blood pressure and body weight. Side effects include increased urinary frequency, owing to their mild diuretic action, symptoms of hypovolemia, genitourinary infections. There are also recent reports of rare cases of diabetic ketoacidosis occurring in insulin-treated patients. Recently, a large cardiovascular outcome trial reported that a specific SGLT2 inhibitor, empagliflozin, led to a reduction in the primary endpoint of major cardiovascular events. This effect was mainly the result of a surprising 38 % reduction in cardiovascular death, and the drug was also associated with nearly as large a reduction in heart failure hospitalization. These findings were notable because most drugs used in type 2 diabetes have not been shown to improve cardiovascular outcomes. Accordingly, there is growing interest in empagliflozin and the entire SGLT2 inhibitor class as drugs that could potentially change the manner in which we approach the management of hyperglycemia in patients with type 2 diabetes.

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          Author and article information

          Journal
          Endocrine
          Endocrine
          Springer Nature
          1559-0100
          1355-008X
          Aug 2016
          : 53
          : 2
          Affiliations
          [1 ] Department of Medicine, Griffin Hospital, Derby, CT, USA.
          [2 ] Department of Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA. silvio.inzucchi@yale.edu.
          Article
          10.1007/s12020-016-0943-4
          10.1007/s12020-016-0943-4
          27270407
          620ea91b-3ef1-47d3-8a4a-4dbb7a52f2fc
          History

          Antihyperglycemic therapy,SGLT2 inhibitors,Type 2 diabetes mellitus

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