A Call for a New Paradigm for Diabetes Care in the Era of Sodium–Glucose Cotransporter 2 Inhibitors (SGLT2i)

Abstract

Abstract In 2013, canagliflozin was the first sodium–glucose cotransporter 2 inhibitor (SGLT2i) approved by the US Food and Drug Administration for the treatment of type 2 diabetes (T2DM). Today, there are four SGLT2i approved for T2DM, and some SGLT2i have been approved for indications beyond glucose control. For example, SGLT2i reduce major adverse clinical events (MACE) including nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death (canagliflozin); cardiovascular death (empagliflozin, dapagliflozin); diabetic kidney disease progression (canagliflozin); and heart failure hospitalization (canagliflozin, dapagliflozin). However, despite the potential benefits of SGLT2i in reducing adverse clinical events, providers underprescribe SGLT2i for eligible patients. Thus, we propose the CKD-PCP framework which allows multiple providers to utilize the benefits of SGLT2i. CKD-PCP has dual meaning: it applies to providers who most often care for patients with T2DM (Cardiologists, Kidney specialists, Diabetologists, and Primary Care Physicians) and it refers to the benefits of SGLT2i (treatment of Cardiovascular disease, Kidney disease, Diabetes, and reduction of blood Pressure, Calories, and Plasma volume). This article is based on previously conducted studies and the authors disclose their roles in relevant trials in the Acknowledgements.

Keywords

• Heart failure
• Kidney disease
• Proteinuria
• SGLT2 inhibitors
• Type 2 diabetes