SGLT2
INHIBITION:
A NOVEL
TREATMENT
STRATEGY FOR
TYPE 2 DIABETES
MELLITUS
SGLT2 INHIBITOR: WHERE DO THEY FIT IN
THE TREATMENT ALGORITHM
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Monotherapy
Add-on to: MET, SU, PIO
Add-on to oral combo therapy
Double/Triple combo therapy
Add-on to insulin in T2DM
Add-on to insulin in T1DM
IGT/IFG
A1c > 10.0%
SGLT 2 INHIBITION: MEETING UNMET
NEEDS IN DIABETES CARE
Corrects a Novel
Pathophysiologic
Defect
Promotes
Weight Loss
Reduces
Blood
Pressure
Reduces
HbA1c
Improves
Glycemic
Control
and CVRFs
Complements
Action of Other
Antidiabetic
Agents
Reversal of
Glucotoxicity
No
Hypoglycemia
OMINOUS OCTET
Decreased
Incretin Effect
Decreased Insulin
Secretion
Islet–a cell
Increased
Glucagon
Secretion
Increased
Lipolysis
ETIOLOGY OF T2DM
Impaired Insulin
Secretion
Increased Lipolysis
Hyperglycemia
Increased
HGP
Decreased Glucose
Uptake
DEFN75-3/99
HYPERGLYCEMI
A
Increased
Glucose
Reabsorption
Increased
HGP
TZDs Neurotransmitter
Dysfunction
MET
GLP1
TZDs
GLP1
EXENATIDE
EXENATIDE
AND NO HYPO USED WITH NO SU
Always try GLP-1 RA before Insulin
PATHOPHYSIOLOGIC-BASED
(DEFRONZO) ALGORITHM
Lifestyle +
TRIPLE COMBINATION:
PIO + Metformin
+ GLP-1 Analogue
HbA1c < 6.0%
Insulin use ben/risk