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      Role of Ertugliflozin in the Management of Diabetes Mellitus

      review-article
      1 , , 1
      ,
      Cureus
      Cureus
      monotherapy, glycemic control, renal hypoglycemia, cardiovascular effects, ertugliflozin, insulin, diabetes mellitus, sglt2 inhibitor

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          Abstract

          The novel oral sodium-glucose cotransporter-2 (SGLT2) inhibitor Ertugliflozin (SteglatroTM) is introduced as a monotherapy or in conjunction with another antidiabetic drug regimen for the treatment of type 2 diabetes mellitus (T2DM).Additional safe and efficient treatment options for patients and physicians are of utmost importance as the incidence of T2DM rises. As a standalone therapy or an adjunctive treatment, ertugliflozin seems to be a reliable and safe option.This narrative review seeks to report and analyze ertugliflozin's effectiveness, safety, cardiovascular (CV), and renal outcomes in T2DM. Various combinations of drugs and drug classes have been tried to reduce mortality and comorbidities associated with the use of antidiabetic agents, especially cardiogenic events and renal diseases. With the administration of hypoglycemic drugs like ertugliflozin and the regulation of blood sugar levels, the incidence of therapy-induced hypertension, obesity, and dose-related hypoglycemia has been reduced to a significant extent. Additionally, ertugliflozin prevents hypertension caused by prolonged antidiabetic drug intake, which is advantageous for lowering the chances of end-stage cardiac events in type 2 diabetic patients. As far as the renal safety profile of ertugliflozin is concerned, it has been associated with the maintenance of eGFR (estimated glomerular filtration rate) and a decreased UACR (urine albumin-to-creatinine ratio) in patients with T2DM and coronary artery disease, which reduces the incidence of renal adverse effects due to long-term medication. As a result of common pathophysiological mechanisms, SGLT2 inhibitors represent a feasible therapeutic option and are advantageous for patients with type 1 and type 2 DM in terms of cardiovascular and renal outcomes.

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          Most cited references35

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          Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.

          The effects of empagliflozin, an inhibitor of sodium-glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known.
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            Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes

            Background Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. Methods The CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results The mean age of the participants was 63.3 years, 35.8% were women, the mean duration of diabetes was 13.5 years, and 65.6% had a history of cardiovascular disease. The rate of the primary outcome was lower with canagliflozin than with placebo (occurring in 26.9 vs. 31.5 participants per 1000 patient-years; hazard ratio, 0.86; 95% confidence interval [CI], 0.75 to 0.97; P<0.001 for noninferiority; P=0.02 for superiority). Although on the basis of the prespecified hypothesis testing sequence the renal outcomes are not viewed as statistically significant, the results showed a possible benefit of canagliflozin with respect to the progression of albuminuria (hazard ratio, 0.73; 95% CI, 0.67 to 0.79) and the composite outcome of a sustained 40% reduction in the estimated glomerular filtration rate, the need for renal-replacement therapy, or death from renal causes (hazard ratio, 0.60; 95% CI, 0.47 to 0.77). Adverse reactions were consistent with the previously reported risks associated with canagliflozin except for an increased risk of amputation (6.3 vs. 3.4 participants per 1000 patient-years; hazard ratio, 1.97; 95% CI, 1.41 to 2.75); amputations were primarily at the level of the toe or metatarsal. Conclusions In two trials involving patients with type 2 diabetes and an elevated risk of cardiovascular disease, patients treated with canagliflozin had a lower risk of cardiovascular events than those who received placebo but a greater risk of amputation, primarily at the level of the toe or metatarsal. (Funded by Janssen Research and Development; CANVAS and CANVAS-R ClinicalTrials.gov numbers, NCT01032629 and NCT01989754 , respectively.).
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              Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes

              The cardiovascular safety profile of dapagliflozin, a selective inhibitor of sodium-glucose cotransporter 2 that promotes glucosuria in patients with type 2 diabetes, is undefined.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                12 November 2022
                November 2022
                : 14
                : 11
                : e31404
                Affiliations
                [1 ] Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
                Author notes
                Article
                10.7759/cureus.31404
                9744393
                36523727
                f2dc4995-10dc-4cb8-82c2-f73d51a82047
                Copyright © 2022, Totade et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 10 August 2022
                : 12 November 2022
                Categories
                Family/General Practice
                Internal Medicine

                monotherapy,glycemic control,renal hypoglycemia,cardiovascular effects,ertugliflozin,insulin,diabetes mellitus,sglt2 inhibitor

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