Renoprotective effect of SGLT-2 inhibitors vs ACE inhibitors in type 2 diabetes (presentation)
Abstract
Abstract
Introduction: Type 2 diabetes mellitus (DM2) is one of the most prevalent diseases worldwide today, and consistently growing over the years. The illness is marked by progressively increased insulin resistance in the body’s cells, leading to glucose overload, and eventually cell and organ damage and death. One end result of DM2 is nephropathy. The current first-line treatment for DM2 is a class of drugs called angiotensin-converting-enzyme inhibitors (ACE inhibitors). ACE inhibitors are considered reno-protective, but eventually nephropathy occurs in patients taking the drug regardless. This paper will address the efficacy of a new alternative diabetes drug, sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors), compared to ACE inhibitors in preventing nephropathy in patients with DM2.
Methods: A literature search was completed through Google Scholar, Ovid, and PubMed in November 2018. Seven articles written on randomized clinical trials were selected based on their relevance to the research question, outcome measurements, and results.
Results: Based on the literature review, SGLT2 inhibitors do serve a statistically significant reno-protective function, as well as a cardioprotective function. However, the extent of the benefit gained from SGLT2 inhibitors is comparable to ACE inhibitors. Furthermore, the wealth and age of evidence for SGLT2 inhibitors are both drastically less than those of ACE inhibitors, resulting in a weak evidence base to support switching first-line treatment from ACE inhibitors to SGLT2 inhibitors.
Discussion: The studies in this paper all showed statistically significant positive results for multiple populations with regard to reducing typical markers of nephropathy. However, the novelty of SGLT2 inhibitors has left the question of truly chronic treatment of DM2 retaining reno-protectivity open to debate. The statistically significant results are also very comparable with those of ACE inhibitors, resulting in a lack of clinical significance. In one study, SGLT2 inhibitors had an increase in number of amputations, which may be a rare but serious adverse outcome of the drug.
Conclusion: Based on the evidence and analysis of results in this paper, SGLT2 inhibitors lack the scientific evidence to replace ACE inhibitors as the first-line treatment in patients with DM2. The significant positive findings in the current studies do not significantly exceed those of the current standard of care and the negative findings may be reason to use SLGT2 inhibitors as only second- or third-line. The longevity of SGLT2 inhibitor use is also lacking, and most cases of DM2-related nephropathy occur decades after diagnosis. The only truly clinically significant possibility is that perhaps SGLT2 inhibitors may be a good first-line choice where ACE inhibitors are not indicated, such as African American patients with DM2. Further and continued research is needed to establish the reno-protective benefits of SGLT2 inhibitors as well as the adverse outcomes.
Renoprotective effect of SGLT-2 inhibitors vs ACE inhibitors in type 2 diabetes (presentation)
Abstract
Introduction: Type 2 diabetes mellitus (DM2) is one of the most prevalent diseases worldwide today, and consistently growing over the years. The illness is marked by progressively increased insulin resistance in the body’s cells, leading to glucose overload, and eventually cell and organ damage and death. One end result of DM2 is nephropathy. The current first-line treatment for DM2 is a class of drugs called angiotensin-converting-enzyme inhibitors (ACE inhibitors). ACE inhibitors are considered reno-protective, but eventually nephropathy occurs in patients taking the drug regardless. This paper will address the efficacy of a new alternative diabetes drug, sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors), compared to ACE inhibitors in preventing nephropathy in patients with DM2.
Methods: A literature search was completed through Google Scholar, Ovid, and PubMed in November 2018. Seven articles written on randomized clinical trials were selected based on their relevance to the research question, outcome measurements, and results.
Results: Based on the literature review, SGLT2 inhibitors do serve a statistically significant reno-protective function, as well as a cardioprotective function. However, the extent of the benefit gained from SGLT2 inhibitors is comparable to ACE inhibitors. Furthermore, the wealth and age of evidence for SGLT2 inhibitors are both drastically less than those of ACE inhibitors, resulting in a weak evidence base to support switching first-line treatment from ACE inhibitors to SGLT2 inhibitors.
Discussion: The studies in this paper all showed statistically significant positive results for multiple populations with regard to reducing typical markers of nephropathy. However, the novelty of SGLT2 inhibitors has left the question of truly chronic treatment of DM2 retaining reno-protectivity open to debate. The statistically significant results are also very comparable with those of ACE inhibitors, resulting in a lack of clinical significance. In one study, SGLT2 inhibitors had an increase in number of amputations, which may be a rare but serious adverse outcome of the drug.
Conclusion: Based on the evidence and analysis of results in this paper, SGLT2 inhibitors lack the scientific evidence to replace ACE inhibitors as the first-line treatment in patients with DM2. The significant positive findings in the current studies do not significantly exceed those of the current standard of care and the negative findings may be reason to use SLGT2 inhibitors as only second- or third-line. The longevity of SGLT2 inhibitor use is also lacking, and most cases of DM2-related nephropathy occur decades after diagnosis. The only truly clinically significant possibility is that perhaps SGLT2 inhibitors may be a good first-line choice where ACE inhibitors are not indicated, such as African American patients with DM2. Further and continued research is needed to establish the reno-protective benefits of SGLT2 inhibitors as well as the adverse outcomes.