Sglt2 Inhibitor: An Antidiabetic, Cardioenhancer, Renoprotector…or the Internist's Elixir?
Revisão Narrativa - Uma narrativa baseada na história e na prova
DOI:
https://doi.org/10.24950/rspmi.2183Keywords:
Diabetes Mellitus, Type 2/drug therapy, Heart Failure/drug therapy, Internal Medicine, Renal Insufficiency, Chronic/drug therapy, Sodium-Glucose Transporter 2 Inhibitors/ therapeutic useAbstract
This review article addresses the history, underlying evidence, proposed mechanisms, and clinical implication of
sodium glucose cotransporter type 2 inhibitors (SGLT2i),
framing them from the perspective of the general practitioner internist of the present decade.
The sodium glucose cotransporter inhibitors, once
identified in the apple tree root bark but with no obvious
therapeutic purpose, were initially developed as another hypoglycemic agent. Recently, its use has undergone a reversal. Large randomized controlled clinical trials revealed: first drug class to improve cardiovascular outcomes and mortality in type 2 diabetes; one more prognosis-modifying class in heart failure; first class with clear benefit in prognosis and even mortality in chronic kidney disease. The mechanisms are still not completely understood, but hypotheses include a diuretic effect and metabolism modulation.
Internal Medicine, as a differentiating generalist specialty,
is par excellence able to deal with the all spectrum use of SGLT2i.
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