SGLT-2 Inhibitors: An Evidence-Based Perspective

Diabetes mellitus (DM) is one of the most prevalent diseases of modern society. There are several therapeutic options available, but they also have many shortcomings. With the limitations and pitfalls of the existing therapies of diabetes, there is always a need for better drugs. This review is an attempt to give comprehensive details about the merits and demerits of a class of drugs called SGLT-2 inhibitors. SGLT-2 inhibitors act by increasing glucose excretion through urine and do not have any effect on insulin secretion, therefore, the risk of hypoglycemia is less. SGLT-2 inhibitors that are in clinical use are: dapagliflozin, empagliflozin, canagliflozin, and ertugliflozin. Considering the benefits offered by SGLT-2 inhibitors over existing antidiabetics, they deserve an important place in the therapy of T2DM and are found to be useful in T1DM, as studies have suggested previously. Beneficial effects of these drugs extend beyond controlling hyperglycemia, e.g., reduction in body weight, reduction in blood pressure and a proven and appreciable reduction in cardiovascular adverse events, maintenance of arterial elasticity and decrease in visceral adipose tissue deposition. The demonstration of such beneficial effects in various clinical studies has established them as one of the important components of antidiabetic therapy. However, in the light of recent safety concerns raised on such molecules would help prescribers to take an informed decision about risks versus benefits while prescribing these agents to their patients.

Keywords: Canagliflozin, Dapagliflozin, Diabetes mellitus, Empagliflozin, Hyperglycemia, Mycotic genital infections, Osmotic diuresis, SGLT-2 inhibitors.