2 Oct 2023 • Doctors, what do you think?🤔

Are SGLT2 Inhibitors really the New Statins?🤷‍♂️

Well, you might be able to answer once you hear the story of how the 'flozins' or SGLT2 Inhibitors were developed.🧐

History of SGLT2i dates back to the isolation of phlorizin from the root bark of apple tree in 1835, which was subsequently followed by the discovery of its glucosuric effects and plasma glucose lowering effects in 1886.

Fast forward to the 20th century, research established that glucose is almost fully reabsorbed using active transport in the proximal renal tubules.🏅

When the co-transporter responsible for this active transport is inhibited, both glucose and sodium are excreted in the urine.

Phlorizin was recognised as a competitive inhibitor of this active transport, and eventually the first ever phlorizin analogs or SGLT-2 inhibitors were developed in 1996.

So how do they work?👩🏻‍⚕

These drugs (namely dapagliflozin, canagliflozin and empagliflozin) work by reducing renal glucose reabsorption and increasing urinary glucose excretion and were approved by the FDA for treatment of T2DM in 2012.✅

Well, statins have been famed for their use as risk - based primary prevention of heart failure. So why flozins?🤷‍♀️

Here's why....

The first RCT in 2015 with empagliflozin in patients with T2DM and CVD with reduced EF reported 14% reduction of primary end - point (cardiovascular death, non- fatal MI or stroke) and similar findings were also confirmed with canagliflozin and dapagliflozin.🔎

In due course, four treatment paradigms were established in clinical practice with the advent of SGLT2i:

• Reduction of development and progression of heart failure in patients with T2DM and CVD with reduced EF.
• Improvement of outcomes in patients with HFrEF irrespective of the presence or absence of T2DM
• Appreciation of the benefits in patients with chronic HF over a wide range of ejection fractions
• Decline in the development of end stage renal failure in patients with CKD

Want to learn more? Tune in now!🤗

Click here to watch Are SGLT2 Inhibitors the New Statins? by Dr. Ganapathi Bantwal right here on Medflix💛