Cited by 377Diabetes Treatment and ManagementIon Transport and Channel RegulationMetabolism, Diabetes, and Cancer

Development of SGLT1 and SGLT2 inhibitors

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Rieg, Timo, Vallon, Volker·2018·Diabetologia

Abstract

Sodium-glucose cotransporters SGLT1 (encoded by SGLT1, also known as SLC5A1) and SGLT2 (encoded by SGLT2, also known as SLC5A2) are important mediators of epithelial glucose transport. While SGLT1 accounts for most of the dietary glucose uptake in the intestine, SGLT2 is responsible for the majority of glucose reuptake in the tubular system of the kidney, with SGLT1 reabsorbing the remainder of the filtered glucose. As a consequence, mutations in the SLC5A1 gene cause glucose/galactose malabsorption, whereas mutations in SLC5A2 are associated with glucosuria. Since the cloning of SGLT1 more than 30 years ago, big strides have been made in our understanding of these transporters and their suitability as drug targets. Phlorizin, a naturally occurring competitive inhibitor of SGLT1 and SGLT2, provided the first insights into potential efficacy, but its use was hampered by intestinal side effects and a short half-life. Nevertheless, it was a starting point for the development of specific inhibitors of SGLT1 and SGLT2, as well as dual SGLT1/2 inhibitors. Since the approval of the first SGLT2 inhibitor in 2013 by the US Food and Drug Administration, SGLT2 inhibitors have become a new mainstay in the treatment of type 2 diabetes mellitus. They also have beneficial effects on the cardiovascular system (including heart failure) and the kidney. This review focuses on the rationale for the development of individual SGLT2 and SGLT1 inhibitors, as well as dual SGLT1/2 inhibition, including, but not limited to, aspects of genetics, genetically modified mouse models, mathematical modelling and general considerations of drug discovery in the field of metabolism.

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  • For type 2 diabetes, complementary disease-modifying therapies may reduce or eliminate the need for insulin administration.

    “For type 2 diabetes, complementary disease-modifying therapies that may reduce or eliminate the need for insulin administration have also represented a rapidly expanding field of interest130–132.”

    From 100 years of insulin: celebrating the past, present and future of diabetes therapy (2021) · cites this paper as [131]

    The Introduction describes SGLT inhibitors as glucose-lowering treatments for type 2 diabetes, and ‘Why target glucose handling in the kidney?’ reports cardiovascular and renal benefits. Neither passage says these therapies reduce or eliminate the need for insulin administration; the Perspectives section discusses adding inhibitors to insulin in type 1 diabetes instead. The claimed effect on insulin use in type 2 diabetes is therefore unsupported. (LLM, conf=0.84)

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Authors
Rieg, T., & Vallon, V.
Affiliations
  • University of South Florida (US)
  • University of California San Diego (US)
Corresponding author
  • Rieg, Timo
  • Vallon, Volker
Venue
Diabetologia
Published
2018-08-22
Volume
61
Issue
10
Pages
2079-2086
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
OpenAlex
W2883581800
Cited by
377
References
71
Citations by year
2026: 39 · 2025: 53 · 2024: 49 · 2023: 66 · 2022: 58 · 2021: 50 · 2020: 36 · 2019: 24 · 2018: 2
FWCI
4.35
Type
journal article
Language
en
Open access
Locations
  • Diabetologia (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK112042)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Ion Transport and Channel Regulation
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
Keywords
SGLT1 inhibitors, SGLT2 inhibitors, sodium-glucose cotransporter, SGLT1, SLC5A2, phloridzin, glucose-galactose malabsorption, glycosuria, type 2 diabetes, heart failure, renal protection, drug discovery, mathematical modeling, genetically engineered mouse models, intestinal glucose absorption, renal glucose reabsorption
MeSH terms
Sodium-Glucose Transporter 2 Inhibitors, Animals, Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Disease Models, Animal, Glucose, Humans, Intestinal Mucosa, Kidney, Mutation, Phlorhizin, Drug Design, Diabetic Ketoacidosis, Sodium-Glucose Transporter 1, Sodium-Glucose Transporter 2, Mice

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