Sodium-glucose co-transporter inhibitors

Inhibition of the sodium-glucose co-transporter 2 in the kidney lowers blood glucose by increasing glucose excretion in the urine. The associated osmotic diuresis and urinary loss of sodium reduces blood pressure. Canagliflozin and dapagliflozin are sodium-glucose co-transporter 2 inhibitors that have been studied as monotherapy and in combination with other drugs for type 2 diabetes. They reduce concentrations of glycated haemoglobin by 6-9 mmol/mol (0.5-0.8%) more than placebo. Patients may lose 2-3 kg during treatment. Hypoglycaemia is more likely to occur if a sodium-glucose co-transporter 2 inhibitor is used in combination with other drugs that lower blood glucose. Low density lipoprotein cholesterol increases during treatment. Glycosuria increases the risk of genitourinary infections. Increased calcium excretion could potentially reduce bone density. Long-term studies are investigating the cardiovascular safety of these drugs. These studies could also yield data about a possible increased risk of malignancy.