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Clinician’s Corner: SGLT2 INHIBITORS “Glucuretics”

SGLT2 inhibitors are another class of drugs that get a lot of advertising on TV.  The morning shows are full of Jardiance and Farxiga commercials. One thing you won’t learn from the commercial, these medications although are very effective, they are rather expensive.

HOW they work: First off they do not need insulin to work, like almost every other category of drug.  They adjust your kidneys re-absorption of glucose making sugar spill into the urine. About 350 calories per day are flushed away, as well as lowering blood sugar levels.  SGLT2 inhibitors “dial back” the glucose threshold of glucose spilling from the kidney from 180mg to about 80 or 90mg/dl.

Negative effects of SGLT2 therapy:

  • Increase in genital infections and urinary tract infections
  • Cant be used if the patient has poor kidney function

Positive effects of SGLT2 Inhibitors:

  • No hypoglycemia (low blood sugars)
  • As monotherapy or added to metformin will see reductions in blood pressure of 3-5mmHg systolic and 2mmHg diastolic.
  • No change in heart rate
  • No dizziness
  • Weight loss (losing 50-85gm of glucose equates to 200-340 kcal/day) There are 3,500 calories to a pound of fat so you could theoretically lose 1 pound every 10 days with this class of drugs.
  • Mechanism of action is INDEPENDENT of insulin secretion.

Precautions for SGLT2 Inhibitors

  • Dehydration – especially if:
    • have low blood pressure
    • take medicines to lower your blood pressure, including water pills (diuretics)
    • are on a low salt diet
    • have kidney problems
    • are 65 years of age or older.
  • Vaginal yeast infection.
  • Yeast infection of the penis.

DRUGS IN THE SGLT2 class

Canagliflozin  (Invokana®)  (Johnson & Johnson)   approved April 2013

  • only lowers CV risk

Dapagliflozin (Farxiga®)    (AstraZeneca)   approved January 2014

Empagliflozin  (Jardiance®)  (Boehringer/Ingelheim)    approved August 2014

  • Reduces both CV risk and death

Ertugliflozin  (Steglatro®)       (Merck)           approved Dec 2017

This new class of diabetes drugs are very effective and have minimal side effects.  Always consult your Thompson Pharmacist, especially if you have any itching or burning in the genital region. This includes the guys too!

Because Invokana, Farxiga and Jardiance have a price tag of $500.00 per month, and Steglatro has a $300.00 price per month, consult your Thompson Pharmacist for more affordable treatment options for your Type-2 diabetes if you don’t have insurance or if you high deductibles.