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SGLT2 Inhibitors – The New Standard of Care for Cardiovascular, Renal and Metabolic Protection in Type 2 Diabetes: A Narrative Review

Samuel Seidu, Vicki Alabraba, Sarah Davies, Philip Newland-Jones, Kevin Fernando, Steve Bain Orcid Logo, Jane Diggle, Marc Evans, June James, Naresh Kanumilli, Nicola Milne, Adie Viljoen, David C. Wheeler, John P. H. Wilding Orcid Logo

Diabetes Therapy, Volume: 15, Issue: 5, Pages: 1099 - 1124

Swansea University Author: Steve Bain Orcid Logo

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DOI (Published version): 10.1007/s13300-024-01550-5

Abstract

A substantial evidence base supports the use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in the treatment of type 2 diabetes mellitus (T2DM). This class of medicines has demonstrated important benefits that extend beyond glucose-lowering efficacy to protective mechanisms capable of slowin...

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Published in: Diabetes Therapy
ISSN: 1869-6953 1869-6961
Published: Springer Science and Business Media LLC 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa65982
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Abstract: A substantial evidence base supports the use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in the treatment of type 2 diabetes mellitus (T2DM). This class of medicines has demonstrated important benefits that extend beyond glucose-lowering efficacy to protective mechanisms capable of slowing or preventing the onset of long-term cardiovascular, renal and metabolic (CVRM) complications, making their use highly applicable for organ protection and the maintenance of long-term health outcomes. SGLT2is have shown cost-effectiveness in T2DM management and economic savings over other glucose-lowering therapies due to reduced incidence of cardiovascular and renal events. National and international guidelines advocate SGLT2i use early in the T2DM management pathway, based upon a plethora of supporting data from large-scale cardiovascular outcome trials, renal outcomes trials and real-world studies. While most people with T2DM would benefit from CVRM protection through SGLT2i use, prescribing hesitancy remains, potentially due to confusion concerning their place in the complex therapeutic paradigm, variation in licensed indications or safety perceptions/misunderstandings associated with historical data that have since been superseded by robust clinical evidence and long-term pharmacovigilance reporting. This latest narrative review developed by the Improving Diabetes Steering Committee (IDSC) outlines the place of SGLT2is within current evidence-informed guidelines, examines their potential as the standard of care for the majority of newly diagnosed people with T2DM and sets into context the perceived risks and proven advantages of SGLT2is in terms of sustained health outcomes. The authors discuss the cost-effectiveness case for SGLT2is and provide user-friendly tools to support healthcare professionals in the correct application of these medicines in T2DM management. The previously published IDSC SGLT2i Prescribing Tool for T2DM Management has undergone updates and reformatting and is now available as a Decision Tool in an interactive pdf format as well as an abbreviated printable A4 poster/wall chart.
Keywords: Cardiovascular, renal and metabolic protection; Oral glucose-lowering medicines; SGLT2is; Sodium-glucose cotransporter-2 inhibitors; Standard of care; Type 2 diabetes mellitus
College: Faculty of Medicine, Health and Life Sciences
Funders: A. Menarini Farmaceutica Internazionale SRL has fully funded the creation of this manuscript and has reviewed and certified it for technical accuracy (Dec 2023 | PP-NP-UK-0015). A. Menarini Farmaceutica Internazionale SRL also provided funding for the journal’s Rapid Service Fee. All authors had full access to all of the data discussed in the paper and take responsibility for the integrity of the information presented.
Issue: 5
Start Page: 1099
End Page: 1124

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