SGL2 Inhibitors in 2020

Dr KK Aggarwal

President CMAAO and HCFI

In 2020, the American Diabetes Association is making two paradigm-shifting recommendations in the treatment of type 2 diabetes.

1.      Prescribe Sodium glucose co-transporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists to patients at high risk for atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, in addition to patients with already established disease, as previously recommended.

2.      Consideration for use of those drugs be independent of the patient's baseline A1c or individualized A1c target. Previously, additional pharmacologic agents were recommended only when A1c was above target despite using first-line metformin and lifestyle interventions.

Atherosclerotic CV Disease: Add Empagliflozin

Heart Failure: Empagliflozin, canagliflozin or dapagliflozin. For patients with heart failure with reduced ejection fraction (HFrEF) who have persistent symptoms and an elevated serum natriuretic peptide level on optimal pharmacologic and device therapy, add dapagliflozin.

CKD:  Canagliflozin in patients with diabetes and proteinuria: In patients with type 2 diabetes who have nephropathy (urine albumin excretion >300 mg per day) and eGFR >30 mL/min per 1.73 m², add Canagliflozin (CREDENCE trial).

In addition, SGLT2 inhibitors in general may have a role as a third agent in those who cannot or will not take insulin, when full doses of metformin and a sulfonylurea have not produced satisfactory metabolic control, or in patients in whom risk of hypoglycaemia is high (frail, older adults) or in whom avoidance of weight gain is a priority. 

FDA on endocrine drugs

• The FDA has approved the monoclonal antibody romosozumab to treat osteoporosis in postmenopausal women at high risk for fracture
• The FDA issued a complete response letter declining to approve a new drug application for oral sotagliflozin a first-in-class dual SGLT1 and SGLT2 inhibitor for adult with type 1 diabetes
• FDA approved an oral hydrogel therapy that induces feelings of fullness without adding calories for adults with overweight and obesity
• FDA issued a safety labeling change order to Sprout Pharmaceuticals for the serotonin receptor agonist flibanserin ordering a modification to the boxed warning that states alcohol use is contraindicated when taking the drug.
• FDA approved testosterone undecanoate in an oral capsule to treat men with certain forms of hypogonadism, the agency announced in a press release. The approval marks the first new oral testosterone replacement product in more than 60 years.

·                     The FDA approved marketing of a generic version of testosterone gel 1.62% as replacement therapy for men with hypogonadism.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA