Type 2 Diabetes mellitus.
90% of glucose reabsorption occurring in the proximal tubule takes place thanks to SGLT2. (10% by SGLT1). By inhibiting this, vast amounts of glucose pass into the urine reducing blood glucose.
SGLT2 effects are:
- Glycosuria leading to lowered HbA1c, lowered calorie intake and thereby weight loss
- Osmotic Diuresis leading to hypotension/dehydration
- Reduction in sodium reuptake, lowering systolic blood pressure
- Glycosuria leads to increased risk of urogenital infection
Oral.
Gliflozins should be used in caution with antihypertensives as this can increase the risk of hypotension. Caution should also be exercised with antidiabetic drugs as this increases the risk of hypoglycaemia.
SGLT2 inhibitors have been reported to cause serious cases of DKA with patients who have only a mildly elevated blood glucose level. Patients and carers should be educated in the signs and symptoms of DKA and physicians should be testing for raised ketones as well as glucose in patients taking SGLT2 inhibitors.
Educate patients in good diabetic foot care as SGLT2 inhibitors have been associated with higher risk of lower limb amputation.
In those patients with reduced renal capacity the efficacy of gliflozins is reduced given the decreased filtered glucose into the tubule.
