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The Effect of Sodium-Glucose Co-transporter-2 (SGLT-2) Inhibitors on Cardiometabolic Profile; Beyond the Hypoglycaemic Action

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Abstract

Type 2 diabetes mellitus (T2DM) has growing prevalence worldwide and major clinical implications, chiefly cardiovascular (CV) and renal disease burden. Sodium-glucose co-transporter (SGLT)-2 inhibitors are a new drug class in the management of T2DM with a mechanism of action independent of insulin. In addition to their hypoglycaemic effect, SGLT-2 inhibitors appear to have haemodynamic and nephroprotective effects. Studies have consistently showed a modest but significant blood pressure (BP) reduction. Metabolic benefits are also attributed to SGLT-2 inhibitors with a modest but consistent body weight decrease recorded along with improvements in lipid profile and uric acid levels. Remarkable findings of significant cardioprotective effects came from the recent EMPA-REG study with a particular focus on heart failure. In the kidney, SGLT-2 inhibitors reduce hyperfiltration, a precipitant of diabetic nephropathy.

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Abbreviations

ABPM:

Ambulatory blood pressure monitoring

ACR:

Albumin to creatinine ratio

BP:

Blood pressure

CKD:

Chronic kidney disease

CV:

Cardiovascular

DBP:

Diastolic blood pressure

GFR:

Glomerular filtration rate

HCZT:

Hydrochlorothiazide

HDL:

High density lipoprotein

HR:

Hazard ratio

LDL:

Low density lipoprotein

OD:

Once daily

RAAS:

Renin-aldosterone-angiotensin system

SGLT:

Sodium-glucose co-transporter

SBP:

Systolic blood pressure

TG:

Triglycerides

TGF:

Tubuloglomerular feedback

VLDL:

Very low density lipoprotein

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Authors and Affiliations

  1. Renal Unit, Epsom and St. Helier University Hospitals NHS Trust, Wrythe Ln, Carshalton, London, SM5 1AA, UK

    Eirini Lioudaki

  2. Department of Nephrology, University Hospital of Heraklion, Iraklio, Greece

    Eirini Lioudaki, Konstantinos G. Stylianou & Eugenios K. Daphnis

  3. Cardiology Department, St George’s University Hospital NHS, London, UK

    Emmanouil S. Androulakis

  4. Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK

    Martin Whyte

  5. Department of Medicine King’s College Hospital, London, UK

    Martin Whyte

  6. Department of Internal Medicine, University Hospital of Heraklion, Iraklio, Greece

    Emmanouil S. Ganotakis

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  3. Martin Whyte
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  4. Konstantinos G. Stylianou
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  5. Eugenios K. Daphnis
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  6. Emmanouil S. Ganotakis
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Correspondence to Eirini Lioudaki.

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Dr. Eirini Lioudaki declares that she has no conflict of interest. Dr. Emmanouil Androulakis declares that he has no conflict of interest. Dr. Martin Whyte declares that he has no conflict of interest. Dr. Konstantinos Stylianou declares that he has no conflict of interest. Professor Eugenios Daphnis declares that he has no conflict of interest. Professor Emmanouil Ganotakis declares that he has no conflict of interest.

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Lioudaki, E., Androulakis, E.S., Whyte, M. et al. The Effect of Sodium-Glucose Co-transporter-2 (SGLT-2) Inhibitors on Cardiometabolic Profile; Beyond the Hypoglycaemic Action. Cardiovasc Drugs Ther 31, 215–225 (2017). https://doi.org/10.1007/s10557-017-6724-3

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