Benefits beyond glycemic control of SGLT2 . inhibitors

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1. What are SGLT2 inhibitors? Every day, our kidneys filter about 120-150 liters of blood. The blood carries the body's waste products to the glomeruli to be used by the kidney's functional units to remove waste products and excess water. The filtered fluid moves into the renal tubules, where sugar and mineral salts are reabsorbed back into the bloodstream. Waste and excess fluid will be transferred to the bladder as urine and excreted.
Sugar provides an important source of energy for the body and is reabsorbed by the kidneys up to 180g per day in healthy adults. The sugar molecule (glucose) is small enough to be filtered by the glomerulus but is reabsorbed by sodium-glucose co-transporters (SGLTs) in the renal tubules. In which, the SGLT2 transport channel reabsorbs up to 90% of the sugar excreted in the urine. Scientists discovered this co-transporter in the 1980s together with an inhibitor of SGLTs extracted from apple roots. In 1995, with a better understanding of the activity of SGLTs transporters in the body, scientists continued to study the development of potential SGLT2 selective inhibitors in the treatment of diabetes. In 2013, the first SGLT2 inhibitor canagliflozin was approved by the US Drug Administration (FDA). Soon after, dapagliflozin and empagliflozin were approved by the FDA in 2014 for the treatment of type 2 diabetes.
SGLT2 inhibitors inhibit the reabsorption of sugar (glucose) in the renal tubules and increase urinary glucose excretion. In Vietnam, the active ingredients dapagliflozin and empagliflozin are available in many diabetes drug preparations including single as well as combination preparations.

2. Cardiovascular benefits Not only help control blood sugar, SGLT2 inhibitors have been effective in weight loss and blood pressure control from the very beginning. Therefore, the drug is the optimal choice in combination with metformin in patients with inadequate glycemic control with high blood pressure and overweight. The drug lost an average of about 3 kg at 2 years of taking the drug and about 4-5 mmHg compared with other classes of diabetes drugs.
These drugs have been shown to reduce cardiovascular events and deaths in people with type 2 diabetes. Therefore, recently, a number of treatment guidelines around the world suggest considering these drugs as the first choice in diabetics at high cardiovascular risk.
Drugs reduce mortality and hospitalization in heart failure patients independently of glycemic control, benefits seen in nondiabetic heart failure patients. New scientific evidence has changed heart failure guidelines around the world. For the first time in history, a diabetes drug is officially put on par with traditional heart failure medications.

3. Kidney protection benefits SGLT2 inhibitors have also demonstrated their benefits in reducing the progression of chronic kidney disease, reducing albuminuria, and reducing the progression of albuminuria in diabetics. Although not highly effective in glycemic control in people with impaired renal function, the drug may still have renal protective benefits and reduce cardiovascular risk.
4. What to keep in mind when using SGLT2 inhibitors The drug only benefits the right patients after being examined and evaluated, you only take the drug when it is prescribed.
SGLT2 inhibitors cannot be used in patients with type 1 diabetes and the effectiveness of glycemic control is very low in patients with impaired renal function. Avoid these medications if you have a history of ketoacidosis, recurrent or recurrent urinary tract infections, or are in a fluid state or at risk of fluid deficiency.
The cost of medicine a day is quite high compared to other diabetes drugs. Therefore, you may need to talk to your doctor about your economic viability before taking the drug. Similar to other drugs for chronic treatment, the drug is only effective when used for a long time and with adherence to treatment.
Because the drug has the effect of removing sugar and salt, it will also have a diuretic effect similar to an osmotic diuretic. You may find yourself urinating more while taking the medication, including increased nocturia, although this may occur in only a small number of patients.
Medicines can increase the risk of urinary tract infections, you need to clean and drink enough water to reduce this risk. Elderly patients (≥75 years) may be more susceptible to this condition. Tell your doctor or go to the doctor when you see any signs of urinary infection such as painful urination, frequent urination, hematuria, lower abdominal pain...
You may feel more thirsty, you should drink enough water to prevent a drop in blood pressure, although usually the drop in blood pressure is quite mild.
When you experience any discomfort or abnormality while taking the drug, please discuss with your doctor for advice and timely treatment. Adherence to treatment and regular follow-up visits are key to ensuring safe and effective chronic disease treatment.
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