Abstract
Type 2 diabetes is becoming a common problem in young obese people and, in some parts of the world, is as common as type 1 diabetes in teenagers and young adults. However, patients that are included in the Phase III trials of new antidiabetic drugs tend to be middle-aged and elderly and, at this point in time, there is little information on the effects of sodium glucose cotransporter 2 (SGLT2) inhibitors in patients under 19 or over 75 years of age. Similarly, until there is much more safety data on SGLT2 inhibitors, these drugs are untested in pregnancy and gestational diabetes or in patients with serious liver disease. In pregnancy, the renal threshold for glucose reduces (i.e., glucose spills over into the urine at a lower blood glucose concentration), and so different clinical effects can be anticipated when compared to the nonpregnant population. Thus, this chapter will omit these patients and focus on the effects of SGLT2 inhibitors in four specific groups of patients where there is published information on efficacy, safety, or both. This includes:
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Inzucchi SE, Zinman B, Wanner C, Ferrari R, Fitchett D, Hantel S, et al. SGLT2 inhibitors and cardiovascular risk: proposed pathways and review of ongoing outcome trials. Diab Vasc Dis Res. 2015;12:90–100.
Zinman B, Inzucchi SE, Wanner C, Wanner C, Ferrari R, Fitchett D, et al. Rationale, design, and baseline characteristics of a randomized, placebo-controlled cardiovascular outcome trial of empagliflozin (EMPA-REG OUTCOME). Cardiovasc Diabetol. 2014;13:102.
Zinman B, Wanner C, Lachin J, Fitchett D, Bluhmki E, Hantel S, et al; EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Eng J Med. 2015;373:2117–28.
Ptaszynska A, Hardy E, Johnsson E, Parikh S, List J. Effects of dapagliflozin on cardiovascular risk factors. Postgrad Med. 2013;125:181–9.
Neal B, Perkovic V, de Zeeuw D, Mahaffey KW, Fulcher G, Stein P, et al. Rationale, design, and baseline characteristics of the Canagliflozin Cardiovascular Assessment Study (CANVAS) – a randomized placebo-controlled trial. Am Heart J. 2013;166:217–23.
Kohan DE, Fioretto P, Tang W, List JF. Long-term study of patients with type 2 diabetes and moderate renal impairment shows that dapagliflozin reduces weight and blood pressure but does not improve glycemic control. Kidney Int. 2014;85:962–71.
Yale JF, Bakris G, Cariou B, Nieto J, David-Neto E, Yue D, et al; DIA3004 Study Group. Efficacy and safety of canagliflozin over 52 weeks in patients with type 2 diabetes mellitus and chronic kidney disease. Diabetes Obes Metab. 2014;16:1016–27.
Barnett AH, Mithal A, Monassie J, Jones R, Rattunde H, Woerle HJ, et al; EMPA-REG RENAL Trial Investigators. Efficacy and safety of empagliflozin added to existing antidiabetes treatment in patients with type 2 diabetes and chronic kidney disease: a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2014;2369–84.
Yamout H, Perkovic V, Davies M, Woo V, de Zeeuw D, Mayer C, et al. Efficacy and safety of canagliflozin in patients with type 2 diabetes and stage 3 nephropathy. Am J Nephrol. 2014;40:64–74.
Bode B, Stenlöf K, Harris S, Sullivan D, Fung A, Usiskin K, et al. Long-term efficacy and safety of canagliflozin over 104 weeks in patients aged 55–80 years with type 2 diabetes. Diabetes Obes Metab. 2015;17:294–303.
Stenlöf K, Cefalu WT, Kim KA, Jodar E, Alba M, Edwards R, et al. Long-term efficacy and safety of canagliflozin monotherapy in patients with type 2 diabetes inadequately controlled with diet and exercise: findings from the 52-week CANTATA-M study. Curr Med Res Opin. 2014;30:163–75.
Cherney DZ, Perkins BA, Soleymanlou N, Maione M, Lai V, Lee A, et al. Renal hemodynamic effect of sodium-glucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus. Circulation. 2014;129:587–97.
Wanner C, Inzucchi SE, Lachin MM, Fitchett D, von Eynatten M, Matheus M, et al; EMPA-REG Outcome Investigators. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016;375;323–34.
Fioretto P, de Bruin TW, Johnsson E, Ptaszynska A, Parikh S, List JF, et al. Safety and efficacy of SGLT2 inhibitor dapagliflozin in older patients with type 2 diabetes. Diabetologia. 2013;56:S383. Abstract 954.
Sinclair A, Bode B, Harris S, Vijapurkar U, Mayer C, Fung A, et al. Efficacy and safety of canagliflozin compared with placebo in older patients with type 2 diabetes mellitus: a pooled analysis of clinical studies. BMC Endocr Disord. 2014;14:37.
Perkins BA, Cherney DZI, Partridge H, Soleymanlou N, Tschirhart H, Zinman B, et al. Sodium-glucose cotransporter 2 inhibition and glycemic control in type 1 diabetes: results of an 8-week open-label proof-of-concept trial. Diabetes Care. 2014;37:1480–3.
Pieber TR, Famulla S, Eilbracht J, Cescutti J, Soleymanlou N, Johansen OE, et al. Empagliflozin as adjunct to insulin in patients with type 1 diabetes: a 4-week, randomized, placebo-controlled trial (EASE-1). Diabetes Obes Metab. 2015;17:928–35.
Henry RR, Rosenstock J, Edelman S, Mudaliar S, Chalamandaris AG, Kasichayanula S, et al. Exploring the potential of the SGLT2 inhibitor dapagliflozin in type 1 diabetes: a randomized, double-blind, placebo-controlled pilot study. Diabetes Care. 2015;38:412–9.
Sands AT, Zambrowicz BP, Rosenstock J, Lapuerta P, Bode BW, Garg SK, et al. Sotagliflozin, a dual SGLT1 and SGLT2 inhibitor, as adjunct therapy to insulin in type 1 diabetes. Diabetes Care. 2015;38:1181–8.
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Fisher, M. (2017). Using SGLT2 Inhibitors in Special Populations. In: Essentials of SGLT2 Inhibitors in Diabetes. Adis, Cham. https://doi.org/10.1007/978-3-319-43296-0_4
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DOI: https://doi.org/10.1007/978-3-319-43296-0_4
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