Two-For-One:
SGLT2 Inhibitors Support Diabetes Management As Well As Kidney Function
There is growing evidence that suggests sodium-glucose cotransporter-2 (SGLT2) inhibitors are effective at more than just lowering glucose levels.
Whether used independently or in combination with other glucose-lowering drugs, these widely used medications may benefit glucose levels, blood pressure, weight loss, and more recently, cardiovascular and renal health.
Chronic kidney disease is a well-known complication of diabetes, affecting approximately one in three adults in this population. For individuals who have experienced long-term hyperglycemia, these elevated glucose levels can slowly (or sometimes, more rapidly) damage the kidneys. Acute kidney disease is the step in between the progression from mild kidney damage to chronic kidney disease, and has been associated with an increased risk of developing end-stage kidney disease, chronic kidney disease, and death. Therefore, managing AKD is essential to preventing further kidney damage.
Enter SGLT2 inhibitors.
To examine the potential benefits of using SGLT2 inhibitors in a population of people with type 2 diabetes and AKD, a recent study published in JAMA Network Open in January 2024 aimed to determine whether the use of these drugs reduced the occurrence of major kidney and cardiovascular events and death within this specific patient population.
In their retrospective cohort study of over 230,000 patients with type 2 diabetes and AKD, investigators identified more than 5,300 individuals as SGLT2 inhibitor users. After a median follow-up period of 2.3 years, study authors compared the two groups, and found that using SGLT2 inhibitors was associated with a substantial reduction in mortality, as well as a significant decrease in major adverse kidney and cardiovascular events. Additionally, study authors observed that use of this medication class even lowered the risk of death, major adverse kidney events and major adverse cardiovascular events among individuals who already had advanced chronic kidney disease.
The clinical impact of SGLT2 inhibitors used for this purpose is tremendous.
Among their many other notable benefits, taking these medications may also prevent progression to more severe kidney disease, which is a major concern among people with diabetes. However, despite being recommended by the American Diabetes Association, authors noted the incredibly low (2.3%) prescription rate of SGLT2 inhibitors among their study population. This perhaps indicates the need to raise awareness and education about this drug class. This is especially true as increasing evidence shows that preventive benefits are not limited to those with type 2 diabetes.
For example, when SGLT2 inhibitors are used alongside intensive insulin therapy in people with type 1 diabetes, studies show that individuals have improved overall glucose control, leading to more time in range, as well as reductions in daily insulin doses, blood pressure, and body weight.
Though SGLT2 inhibitors have a profoundly positive impact on kidney function, the off-label use of these drugs also has its limitations.
Studies have shown that consistent intake of SGLT2 inhibitors may increase the risk of urinary tract infections, yeast infections, and euglycemic diabetes ketoacidosis (DKA), which can occur when blood glucose levels are within normal range. For this reason, diabetes patients using SGLT2 inhibitors may need to practice extra caution when managing glucose levels to limit these risks.
If you are interested in using SGLT2 inhibitors, we encourage you to reach out to your healthcare provider or one of the clinicians here at Integrated Diabetes Services to discuss your options.
Article by IDS Intern, Krystal Bosenbark, MPH, MS
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