sglt2 inhibition: a novel treatment strategy for type 2 diabetes mellitus
TRANSCRIPT
SGLT2 INHIBITION:
A NOVEL TREATMENT
STRATEGY FOR TYPE 2 DIABETES
MELLITUS
SGLT2 INHIBITOR: WHERE DO THEY FIT IN THE TREATMENT ALGORITHM
●Monotherapy●Add-on to: MET, SU, PIO●Add-on to oral combo therapy●Double/Triple combo therapy ●Add-on to insulin in T2DM●Add-on to insulin in T1DM● IGT/IFG●A1c > 10.0%
SGLT 2 INHIBITION: MEETING UNMETNEEDS IN DIABETES CARE
Corrects a Novel Pathophysiologic
Defect
ReducesHbA1c
Promotes Weight Loss
ComplementsAction of Other
AntidiabeticAgents
Reduces Blood
Pressure NoHypoglycemia
Improves GlycemicControl
and CVRFs
Reversal ofGlucotoxicity
GLP1TZDs
GLP1
GLP1HYPERGLYCEMI
AHYPERGLYCEMI
A
DecreasedIncretin Effect
DecreasedIncretin Effect
Decreased InsulinSecretion
IncreasedHGP
Islet– a cell
IncreasedGlucagonSecretion
OMINOUS OCTET
IncreasedLipolysis
IncreasedGlucose
Reabsorption
NeurotransmitterDysfunction
TZDs
GLP1
TZDsGLP1
TZDsMETGLP1
Decreased Glucose
Uptake
EXENATIDEAND NO HYPO USED WITH NO SU
EXENATIDE
Always try GLP-1 RA before Insulin
PATHOPHYSIOLOGIC-BASED (DEFRONZO) ALGORITHM
Lifestyle +TRIPLE COMBINATION:
PIO + Metformin + GLP-1 Analogue
HbA1c < 6.0%
Insulin use ben/risk