the role of sglt 2 inhibitors in the management of patients with type 2 diabetes n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
The Role of SGLT-2 Inhibitors in the Management of Patients with Type 2 Diabetes PowerPoint Presentation
Download Presentation
The Role of SGLT-2 Inhibitors in the Management of Patients with Type 2 Diabetes

Loading in 2 Seconds...

play fullscreen
1 / 49

The Role of SGLT-2 Inhibitors in the Management of Patients with Type 2 Diabetes - PowerPoint PPT Presentation


  • 242 Views
  • Uploaded on

The Role of SGLT-2 Inhibitors in the Management of Patients with Type 2 Diabetes . Lawrence Blonde, MD Director, Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Diabetes, and Metabolic Diseases Ochsner Medical Center, New Orleans, LA. Disclosures: Lawrence Blonde, MD.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The Role of SGLT-2 Inhibitors in the Management of Patients with Type 2 Diabetes' - fallon


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
the role of sglt 2 inhibitors in the management of patients with type 2 diabetes

The Role of SGLT-2 Inhibitors in the Management of Patients with Type 2 Diabetes

Lawrence Blonde, MD

Director, Ochsner Diabetes Clinical Research Unit,

Department of Endocrinology, Diabetes, and Metabolic Diseases

Ochsner Medical Center, New Orleans, LA

disclosures lawrence blonde md
Disclosures: Lawrence Blonde, MD
  • Clinical research: Boehringer Ingelheim , Eli Lilly, Johnson & Johnson, Novo Nordisk, Roche, Sanofi-aventis
  • Advisor or consultant: Amylin, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, GlaxoSmithKline, Halozyme Therapeutics, Johnson & Johnson, MannKind Corporation, Merck, Novo Nordisk, Orexigen Therapeutics, Roche, Sanofi-aventis, Santarus, VeroScience
  • Speaker/speakers bureau: AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Merck, Novo Nordisk, Santarus, VeroScience
the role of sglt 2 inhibitors in the management of patients with type 2 diabetes1
The Role of SGLT-2 Inhibitors in the Management of Patients with Type 2 Diabetes

This CME activity is supported by an educational grant from:

the role of sglt 2 inhibitors in the management of patients with type 2 diabetes2
The Role of SGLT-2 Inhibitors in the Management of Patients with Type 2 Diabetes

Please complete the questionnaire/evaluation form located in your program books.

case presentation
Case Presentation

48-year-old African American man with 12 month history of type 2 diabetes

Hypertension for past 6 years treated with lisinopril 10 mg daily

Most recent blood pressure was 138/84 mm Hg

Increased LDL-C treated with simvastatin 40 mg qd;

Most recent LDL-C 98 mg/dL

Diabetes treated with lifestyle intervention (increased physical activity, medical nutritional therapy) and metformin 1000 mg bid

Weight 240 pounds, height 6’ (BMI = 32.5)

A1C = 7.5 %

natural history of t2d and cell function
Natural History of T2D and β-cell Function

Bergenstal R, et al. Endocrinology. Philadelphia, PA: WB Saunders Co;2001:821-835.

ominous octet
Ominous Octet

DeFronzo RA. Diabetes. 2009;58:773-795.

survival as a function of a1c in patients type 2 diabetes a retrospective cohort study
Survival as a Function of A1C in Patients Type 2 Diabetes: A Retrospective Cohort Study*

Oral Agents

Insulin +/- Oral Agents

Currie CJ, et al. Lancet. 2010;6(375):481-9.

*28,000 patients 50 years and older

abcs of type 2 diabetes aace ace 2011 and ada 2011
ABCs of Type 2 Diabetes: AACE/ACE 2011 and ADA 2011

*In individuals with overt cardiovascluar disease, a lower LDL-cholesterol goal of <70 mg/dL (1.8 mmol/L), using high-dose of a statin, is an option.

AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. Endocr Pract. 2007;13(suppl 1):1-68.

"Standards of Medical Care in Diabetes—2011." Diabetes Care 34(Supplement 1): S11-S61.

Handelsman Y, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Developing a Diabetes Mellitus Comprehensive Care Plan. Endocr Pract. 2011;17(Suppl 2):1-53.

Standards of Medical Care in Diabetes—2011. Diabetes Care. 34(Supplement 1): S11-S61.

slide10

Glycemic Control Recommendations for Type 2 Diabetes:

AACE/ACE 2011 and ADA 2011

Handelsman Y, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Developing a Diabetes Mellitus Comprehensive Care Plan. Endocr Pract. 2011;17(Suppl 2):1-53.

Standards of Medical Care in Diabetes—2011. Diabetes Care. 34(Supplement 1): S11-S61.

*In individuals with overt cardiovascluar disease, a lower LDL-cholesterol goal of <70 mg/dL (1.8 mmol/L), using high-dose of a statin, is an option.

AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. Endocr Pract. 2007;13(suppl 1):1-68.

"Standards of Medical Care in Diabetes—2011." Diabetes Care 34(Supplement 1): S11-S61.

ada aha acc consensus recommendations from accord advance va diabetes trials
ADA/AHA/ACC Consensus Recommendations From ACCORD, ADVANCE, & VA Diabetes Trials
  • A1C goal for non-pregnant adults in general = < 7.0%
    • Lowering A1C to ≈7.0% has been shown to reduce microvascular and neuropathic complications
  • For selected individual patients, lower A1C goals may be recommended if goal can be achieved without significant hypoglycemia or other adverse events, eg, patients with
    • Short duration of diabetes
    • Long life expectancy
    • No significant cardiovascular disease
  • For some patients, less stringent A1C goals may be appropriate,eg, patients with
    • History of severe hypoglycemia
    • Limited life expectancy
    • Advanced microvascular or macrovascular complications
    • Extensive co-morbid conditions
    • Long-standing diabetes where goals have not been achieved despite optimal Rx

Skyler J, et al. Diabetes Care. 2009;32:187–192.

challenges in type 2 diabetes
Challenges in Type 2 Diabetes
  • Large number of patients
    • Diabetes affects 25.8 million people (8.3 % of the US population)
      • DIAGNOSED- 18.8 million people
      • UNDIAGNOSED- 7.0 million people
      • PREDIABETES – 79 million people
  • Progressive worsening of insulin secretory deficit requiring increased number of antihyperglycemic medications over time
  • Risk for hypoglycemia with some therapies
  • Risk for weight gain with some therapies
  • Difficulty controlling postprandial glucose and glucose fluctuations
  • Preventing and managing complications and co-morbidities
  • Difficulty attaining and sustaining optimal long-term glycemic control

CDC 2010. National Diabetes Fact Sheet. US Department of Health and Human Services.

Cefalu, WT. Am J Med. 2012;343(1):21-26.

ada easd writing goup consensus algorithm
ADA/EASD Writing Goup Consensus Algorithm

*Validation based on clinical trials and clinical judgment

†Sulfonylureas other than glybenclamide (glyburide) or chlorpropamide

Nathan DM, et al. Diabetes Care. 2009:32:193-203.

aace ace diabetes algorithm for glycemic control
AACE/ACE Diabetes Algorithm for Glycemic Control

American Association of Clinical Endocrinologists. AACE/ACE Diabetes Algorithm for Glycemic Control. Available at https://www.aace.com/publications. Accessed January 2012.

summary of key benefits and risks of medications
Summary of Key Benefits and Risks of Medications

American Association of Clinical Endocrinologists. AACE/ACE Diabetes Algorithm for Glycemic Control. Available at https://www.aace.com/publications. Accessed January 2012.

unmet needs with conventional antihyperglycemic therapies
Unmet Needs With Conventional Antihyperglycemic Therapies
  • Many therapies are associated with weight gain
  • Insulin and non incretin oral insulin secretagogue therapies are associated with significant risk for hypoglycemia
  • Other AEs with some therapies include GI side effects and edema
  • Many therapies fail to adequately control postprandial hyperglycemia
  • Therapies often fail to maintain long-term glycemic control

Blonde L. Am J Manag Care. 2007;13:S36-S40.

Blonde L, et al. J Manag Care Pharm. 2006;12(suppl):S2-S12.

unmet needs
Unmet Needs

Type 2 DM Control is Not Durable

3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48

Time (months)

Bloomgarden, ZT. Diabtes Care. 2007;30(1):174-180.

new classes presently in development
New Classes Presently in Development
  • Long-acting GLP-1 receptor agonists
  • Ranolazine
  • Dual & Pan PPAR agonists
  • 11 Hydroxysteroid Dehydrogenase (HSD)- 1 inhibitors
  • Fructose 1,6-bisphosphatase inhibitors
  • Glucokinase activators
  • G protein-coupled Receptor (GPR)- 40 & -119 agonists
  • Protein Tyrosine Phosphatase (PTB)- 1b inhibitors
  • Camitine- Palmitoyltransferase (CPT)- 1 inhibitors
  • Acetyl COA Carboxylase (ACC)- 1 & -2 inhibitors
  • Glucagon receptor antagonists
  • Salicylate derivatives
  • Immunomodulatory drugs
  • Sodium- Glucose Cotransporter (SGLT) {-1} & -2 inhibitors
slide20

The Kidneys Play an Important Role in Glucose Control

  • Normal Renal Glucose Physiology
    • 180 g of glucose is filtered each day
    • Virtually all glucose reabsorbed in the proximal tubules & reenters the circulation
    • SGLT2 reabsorbs about 90% of the glucose
    • SGLT1 reabsorbs about 10% of the glucose
    • Virtually no glucose excreted in urine

Mather, A & Pollock, C. Kidney International. 2011;79:S1-S6.

sodium glucose cotransporters
Sodium- Glucose Cotransporters

Lee YJ, at al. Kidney Int Suppl. 2007;72:S27-S35.

targeting the kidney
Targeting the Kidney

Chao EC, et al. Nat Rev Drug Discovery. 2010;9:551-559.

renal glucose transport
Renal Glucose Transport

Chao, EC & Henry RR. Nature Reviews Drug Discovery. 2010;9:551-559.

altered renal glucose control in diabetes
Altered Renal Glucose Control in Diabetes
  • Gluconeogenesis is increased in postprandial and postabsorptive states in patients with Type 2 DM
    • Renal contribution to hyperglycemia
    • 3-fold increase relative to patients without diabetes
  • Glucose reabsorption
    • Increased SGLT-2 expression and activity in renal epithelial cells from patients with diabetes vs. normoglycemic individuals

Marsenic O. Am J Kidney Dis. 2009;53:875-883.

Bakris GL, et al. Kidney Int. 2009;75(12):1272-1277.

Rahmoune H, et al. Diabetes. 2005;54(12):3427-3434.

rationale for sglt2 inhibitors
Rationale for SGLT2 Inhibitors
  • SGLT2 is a low-affinity, high capacity glucose transporter located in the proximal tubule and is responsible for 90% of glucose reabsorption
  • Mutation in SGLT2 transporter linked to hereditary renal glycosuria, a relatively benign condition in humans
  • Selective SGLT2 inhibitors have a novel & unique mechanism of action reducing blood glucose levels by increasing renal excretion of glucose
  • Decreased glycemia will decrease glucose toxicity leading to further improvements in glucose control
  • Selective SGLT2 inhibition, would also cause urine loss of the calories from glucose, potentially leading to weight loss

Brooks AM, Thacker SM. Ann Pharmacother. 2009;42(7):1286-1293.

effects of sglt2 inhibitors
Effects of SGLT2 Inhibitors

Inhibition of renal tubular Na+- glucose cotransporter

reversal of hyperglycemia

reversal of “glucotoxicity”

Insulin sensitivity in muscle

GLUT4 translocation

Insulin signaling

Insulin sensitivity in liver

Glucose-6-phosphatase

Gluconeogenesis

Decreased Cori Cycle

PEP carboxykinase

Improved beta cell function

DeFronzo RA, et al. Diabetes Obes Metab. 2012;14(1):5-14.

sglt2 inhibitors in phase 3 development
SGLT2 Inhibitors in Phase 3 Development
  • Empagliflozin
  • Canagliflozin
  • Dapagliflozin
  • Ipragliflozin
empagliflozin change in a1c
Empagliflozin: Change in A1C

Randomized, double-blind, 12 week trial comparing

empagliflozin and open-label metformin

*

*

*

*P˂.001 vs. placebo

†500 mg BID for four weeks, then 1000 mg BID or the maximum tolerate dose

Ferrannini E, et al. Abstract 877. EASD 2010.

empagliflozin change in plasma glucose in the fasting state
Empagliflozin: Change in Plasma Glucose in the Fasting State

Randomized, double-blind, 12 week trial comparing

empagliflozin and open-label metformin

*

*

*

*P˂.001 vs. placebo

†500 mg BID for four weeks, then 1000 mg BID or the maximum tolerate dose

Ferrannini E, et al. Abstract 877. EASD 2010.

empagliflozin safety summary
Empagliflozin Safety Summary
  • In Phase 2b study
    • Reported adverse events were comparable among treatment groups
    • Most frequently reported AEs
      • Frequent urination, thirst, and nasopharyngitis
    • Urinary tract infection frequency was low (1.2%) and comparable to placebo (1.2%) and metformin (1.2%)
    • Incidence of genital infection was low: mycosis (0.8%) and pruritis (1.2%) with Empagliflozin versus none with metformin or placebo
    • Rates of hypoglycemia were similar between groups

Ferrannini E, et al. Abstract 877. EASD 2010.

canagliflozin
Canagliflozin

Metformin + Canagliflozin Dose-Ranging Study

Mean Baseline

A1C (%)

7.71 8.01 7.81 7.57 7.70 7.71 7.62

*

*

*

*

*

*

Rosenstock J, et al. Abstract 77-OR. ADA 2010.

*P˂.001 vs. placebo calculated using LS means

canagliflozin1
Canagliflozin

SGLT2 Inhibition for Type 2 Diabetes:

Metformin + Canagliflozin Dose-Ranging Study

Mean Baseline

Weight (kg)

85.5 87.5 87.7 87.7 87.8 86.3 87

*

*

*

*

*

*

*

*P˂.001 vs. placebo calculated using LS means

Rosenstock J, et al. Abstract 77-OR. ADA 2010.

canagliflozin trials
Canagliflozin Trials
  • Symptomatic genital infections in 3-8% canagliflozin arms
    • 2% placebo
    • 2% SITA
  • Urinary tract infections in 3-9% canagliflozin arms
    • 6% placebo
    • 2% SITA
  • Hypoglycemia in 0-6% canagliflozin arms
    • 2% placebo
    • 5% SITA

Rosenstock J, et al. Abstract 77-OR. ADA 2010.

changes from baseline in a1c in phase 3 dapagliflozin studies
Changes from Baseline in A1C in Phase 3 Dapagliflozin Studies

Placebo Dapa 2.5mg Dapa 5mg Dapa 10mg

Wilding JPH, et al. Abstract 78-OR. ADA 2010; Strojek K, et al. Abstract 870. EASD 2010;

Ferrannini E, et al. Diabetes Care. 2010;33(10):2217-2224; Bailey CJ, et al. Lancet. 2010;375(9733):2223-2233.

changes from baseline in fasting plasma glucose in phase 3 dapagliflozin studies
Changes from Baseline in Fasting Plasma Glucose in Phase 3 Dapagliflozin Studies

5

0

-5

mg/dL

-10

-15

-20

-25

-30

Wilding JPH, et al. Abstract 78-OR. ADA 2010; Strojek K, et al. Abstract 870. EASD 2010;

Ferrannini E, et al. Diabetes Care. 2010;33(10):2217-2224; Bailey CJ, et al. Lancet. 2010;375(9733):2223-2233.

changes from baseline in body weight in phase 3 dapagliflozin studies
Changes from Baseline in Body Weight in Phase 3 Dapagliflozin Studies

Placebo Dapa 2.5mg Dapa 5mg Dapa 10mg

Wilding JPH, et al. Abstract 78-OR. ADA 2010; Strojek K, et al. Abstract 870. EASD 2010;

Ferrannini E, et al. Diabetes Care. 2010;33(10):2217-2224; Bailey CJ, et al. Lancet. 2010;375(9733):2223-2233.

monotherapy study summary and conclusion
Monotherapy Study: Summary and Conclusion
  • In treatment-naïve patient with newly-diagnosed Type 2 DM, dapagliflozin monotherapy resulted in
    • Clinically meaningful decreased in A1C and fasting plasma glucose with a near absence of hypoglycemia
    • Favorable effects on weight and blood pressure
  • In the exploratory evening dose cohort, changes from baseline in A1C, fasting plasma glucose, and body weight at week 24 were similar to those seen in the main patient cohort
  • In the high A1C (QAM) exploratory cohort, dapagliflozin elicited a considerable improvement in glycemia

Ferrannini E, et al. Diabetes Care. 2010;33(10):2217-2224.

monotherapy study summary and conclusion1
Monotherapy Study: Summary and Conclusion
  • Increased incidence of urinary tract and genital infections with dapagliflozin treatment:
    • Events suggestive of urinary tract infection were 4%, 4.6%, 12.5%, and 5.7% for placebo, DAPA 2.5mg, 5mg, and 10mg groups, respectively
    • Events suggestive of genital infections were 1.3%, 7.7%, 7.8%, and 12.9% for placebo, DAPA 2.5mg, 5mg, and 10mg groups, respectively
  • Hypoglycemic events occurred in 2.7%, 1.5%, 0%, and 2.9% in patients in placebo, DAPA 2.5mg, 5mg, and 10mg groups, respectively

Ferrannini E, et al. Diabetes Care. 2010;33(10):2217-2224.

dapagliflozin as add on therapy summary and conclusions
Dapagliflozin as Add-on Therapy: Summary and Conclusions
  • Add-on to metformin in patients inadequately controlled with metformin alone
    • Favorable safety parameters and tolerability
    • Improved glycemic control
    • Lowers weight
    • Not associated with risk for hypoglycemia
    • Adverse events occurred in similar proportions
      • Events suggestive of urinary tract infection were 8%, 4%, 7%, and 8% for placebo, DAPA 2.5mg, 5mg, and 10mg groups, respectively
      • Events suggestive of genital infection were 5%, 8%, 13%, and 9% for placebo, DAPA 2.5mg, 5mg, and 10 mg groups respectively
      • Hypoglycemic events occurred in 3%, 2%, 4%, and 4% of patients in placebo, DAPA 2.5mg, 5mg, and 10 mg groups respectively

Bailey CJ, et al. Lancet. 2010;375(9733):2223-2233.

dapagliflozin as add on therapy summary and conclusions1
Dapagliflozin as Add-on Therapy: Summary and Conclusions

Add-on to glimepiride in patients poorly controlled sulfonylurea therapy

  • Significantly improved mean A1C
  • Reduced weight
  • Well-tolerated
  • Adverse events were similar across all treatment groups
    • Events suggestive of urinary tract infection were 6.2%, 3.9%, 6.9%, and 5.3% for placebo, DAPA 2.5mg, 5mg, and 10mg groups, respectively
    • Events suggestive of genital infection were 0.7%, 3.9%, 6.2%, and 6.6% for placebo, DAPA 2.5mg, 5mg, and 10 mg groups respectively
    • Hypoglycemic events occurred in 4.8%, 7.1%, 6.9%, and 7.9% in patients for placebo, DAPA 2.5mg, 5mg, and 10 mg groups respectively

Strojek K, et al. Abstract 870. EASD 2010

dapagliflozin as add on therapy summary and conclusions2
Dapagliflozin as Add-on Therapy: Summary and Conclusions
  • Add-on to insulin in patients poorly controlled with insulin
    • Sustained effectiveness and stable tolerability
    • Less likely to D.C or require insulin up-titration due to poor glycemic control versus placebo
    • Increased frequency of weight loss and reduced frequency of peripheral edema over time
    • Adverse events and discontinuations were balanced across groups
    • Actively solicited signs and symptoms suggestive of urinary tract (UTI) and genital infections (GI) were higher with dapagliflozin vs. placebo
      • Events suggestive of urinary tract infection occurred in 8.4% DAPA vs 4.1% placebo
      • Events suggestive of genital infection occurred in 7.2% DAPA vs 2.0% placebo

Wilding JPH, et al. Abstract 78-OR. ADA 2010

dapagliflozin vs glipizide as add on therapy to metformin 2 years
Dapagliflozin* vs. Glipizide as Add-on Therapy to Metformin: 2 Years

Urinary tract infection: 13.5% for dapagliflozin; 9.1% for glipizide

Genital infection: 14.8% for dapagliflozin ; 2.9% for glipizide

*The FDA has not approved this medication for use.

Nauck MA, et al. Diabetes Care. 2011;34:2015-2022.

dapagliflozin as add on to metformin 2 year extension study
Dapagliflozin as Add-on to Metformin: 2 Year Extension Study
  • Events suggestive of urinary tract infection
    • Dapagliflozin 2.5 mg: 8.0%, 5 mg: 8.8%, 10 mg: 13.3%
    • Placebo: 8.0%
  • Events suggestive of urinary tract infection
    • Dapagliflozin 2.5 mg: 11.7%, 5 mg: 14.6%, 10 mg: 12.6%
    • Placebo: 5.1%
  • Events primarily mild or moderate in intensity and responded to standard treatment

Bailey CJ et al. Abstract 988-P. ADA 2011.

safety malignancies
Safety: Malignancies
  • Bladder cancer incidence rate:
    • 0.16% patients (n=5,478) treated with dapagliflozin vs 0.03% patients (n-3,156) in placebo group (p = 0.15)
  • Breast cancer incidence rate:
    • 0.4% patients (n=2,223) treated with dapagliflozin vs 0.09% patients (n=1,053) in placebo group (p = 0.27)

Jones D. Nat Rev Drug Discov. 2011;10(9):645-646.

ipragliflozin phase 2 studies
Ipragliflozin: Phase 2 Studies

Schwartz S, et al. Safety, Pharmacokinetic, And Pharmacodynamic Profiles Of Ipragliflozin (ASP1941), A Novel And Selective Inhibitor Of Sodium-dependent Glucose Co-transporter 2, In Patients With Type 2 Diabetes Mellitus. Diabetes Technology & Therapeutics. 2011; 13(12): 1219-1227. Wilding J, et al. Efficacy and safety of ipragliflozin in type 2 diabetes patients inadequately controlled on metformin: a dose-finding study. Abst D-0741. IDF 2011.

brighten trial ipragliflozin
BRIGHTEN Trial: Ipragliflozin

Phase 3, Double-blind, Placebo-controlled Study-16 weeks (n=129)

  • Ipragliflozin treatment group 50mg QD (n=62)
    • Ipragliflozin achieved a mean decrease of 1.23% in A1c compared with placebo (p<0.001)
    • FPG was reduced by 45.8mg/dL compared with placebo (p<0.001)
    • Total body weight was reduced by 1.47kg compared with placebo (p<0.001)
    • Similar adverse events occurring in about half the patients in both cohorts.
    • 1 case if hypoglycemia and 2 cases of genital infections in ipragliflozin group

Kashiwagi, A. et al. Ipragliflozin improved glycemic control with additional benefits of reductions of body weight and blood pressure in Japanese patients with type 2 diabetes mellitus: BRIGHTEN Study. Abst 149. EASD 2011

case presentation 1
Case Presentation 1

48-year-old African American man with 12 month history of type 2 diabetes

Hypertension for past 6 years treated with Lisinopril 10 mg daily;

most recent blood pressure was 138/84 mm Hg

Increased LDL-C treated with simvastatin 40 mg qd;

most recent LDL-C 98 mg/dL

Diabetes treated with metformin 1000 mg bid and lifestyle intervention (increased physical activity, medical nutritional therapy)

Weight 240 pounds, height 6’ (BMI = 32.5)

A1C = 7.5 %

case presentation 2
Case Presentation 2

64-year-old Latina with 8 year history of type 2 diabetes

Hypertension for past 6 years treated with Olmesartan 10 mg and HCTZ 12 mg daily

most recent blood pressure was 142/86 mm Hg

Increased LDL-C treated with simvastatin 40 mg qd;

most recent LDL-C 98 mg/dL

Diabetes treated with metformin XR 1500 mg QD; insulin glargine 30 U QHS and lifestyle intervention (increased physical activity, medical nutritional therapy)

Weight 160 pounds, height 5’ 2” (BMI = 29.3)

A1C = 7.5 %; FPG

perspectives on sglt2 inhibition
Perspectives on SGLT2 Inhibition
  • Concerns
    • Polyuria
    • Electrolyte disturbances
    • Bacterial urinary tract infections
    • Fungal genital infections
    • Malignancies
  • Potential advantages
    • Insulin Independence
    • Weight loss (75g urine glucose = 300kcal/day)
    • Low risk of hypoglycemia
    • Blood pressure lowering?