Should All Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease Receive an SGLT2 Inhibitor?
Year: 2018
Type: article
Abstract: Receive an SGLT2 Inhibitor? THE "PRO" SIDEInnovations-ordering groceries online, moving your files to cloud storage, using an app to have a stranger give you a ride-are often approached with uncertainty.Healthy skepticism is useful, particularly for new drugs.In type 2 diabetes mellitus, the story of the ill-fated drug rosiglitazone serves as a cautionary tale: new does not necessarily equal better.In response, the US Food and Drug Administration mandated that pharmaceutical manufacturers be required to conduct randomized controlled trials with the goal of establishing cardiovascular safety for all new antidiabetic drugs. 1 Two recent trials (EMPA-REG OUTCOME 2 and CANVAS 3 ) have demonstrated that sodium glucose co-transporter 2 (SGLT2) inhibitors, a novel class of medications that promote glycosuria by inhibiting glucose reabsorption in the proximal convoluted tubule independent of insulin secretion, are not only safe from a cardiovascular perspective, but actually reduce the risk of meaningful cardiovascular outcomes.The "flozins", as they are known, have purported health benefits beyond glycemic control, including weight loss, reduction in blood pressure, and increase in high-density lipoprotein cholesterol.4 SGLT2 inhibitors should be utilized with watchful optimism, as the observed cardiovascular benefit is nontrivial.However, enthusiasm for these agents is being tempered with appropriate trepidation-no one wants to get "rosiglitazoned" again.The affirmative in this debate can be distilled into 2 key arguments: first, SGLT2 inhibitors have reduced clinically meaningful cardiovascular outcomes in multiple large randomized controlled trials, and second, this evidence stands alone, given that for most other antidiabetic drugs there is an appalling lack of cardiovascular benefit.The EMPA-REG OUTCOME trial compared empagliflozin with placebo in 7020 patients with type 2 diabetes and established cardiovascular disease. 2 After 3.1 years, the primary composite outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke was significantly lower with empagliflozin, for a number needed to treat (NNT) of 63.As well, empagliflozin significantly reduced all-cause death (NNT 39), cardiovascular death (NNT 46), serious adverse events (NNT 53), hospital admissions for heart failure (NNT 72), and incident/worsening
Institution: University of British Columbia
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2890562667