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Development of SGLT1 and SGLT2 inhibitors
Open accessAbstract
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 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]
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Verboven, A. H. A., Puvogel, S., Latour, B. L., Kolsters, N., Lewerissa, E., Mijdam, R., Dyke, E., Duineveld, D. J., Zoodsma, M., Claassen, W. J. J., et al. (2026) · Molecular Psychiatry · doi:10.1038/s41380-026-03482-x · Cited by 3
“…promotes neuronal projection-related transcriptional changes that increase synaptic density and enhance network activity in KdVS neurons and may further support network recovery by reducing oxidative stress, potentially via partial restoration of mitochondrial function and energy metabolism.”
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“Dapagliflozin, as a SGLT2 inhibitor, has been approved by the US Food and Drug Administration as a new class of glucose-lowering agents for the treatment of T2DM, either as monotherapy or as an add-on treatment [4].”
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The Renal Effects of SGLT2 Inhibitors
Sawaf, H., Qaz, M., Ismail, J., & Mehdi, A. (2022) · EMJ Nephrology · doi:10.33590/emjnephrol/22-00080 · Cited by 2
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The role of SGLT2 inhibitors beyond glucose-lowering to cardio-renal protection
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SODIUM-GLUCOSE LINKED COTRANSPORTER 2 INHIBITOR: A NEW HORIZON IN THE TREATMENT OF TYPE-2 DIABETES
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“SGLT2-is, the newest class of oral antidiabetic agents, represent a therapeutic approach for treating T2DM that is independent of insulin secretion and activity.”
BackgroundInfluentialOtto, C., Friedrich, A., Vrhovac, I., Baumeier, C., Schwenk, R. W., Karaica, D., Germer, C.-T., Schürmann, A., Sabolić, I., & Koepsell, H. (2020) · ACS Omega · doi:10.1021/acsomega.0c03844 · Cited by 3
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“To what degree do the reduction of hyperglycemia, weight loss, and reduction of volume overload account for the clinical benefits (4)? Are the protective effects in the kidney responsible for the reduction in major adverse cardiovascular events? What is the contribution of the reduction in glomerular hyperfiltration v…”
BackgroundSodium-Glucose Cotransporter 2 Inhibitors: Mechanisms of Action and Various Effects
Kim, K. (2019) · Journal of Korean Diabetes · doi:10.4093/jkd.2019.20.2.74 · Cited by 3
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“A type 1 SGLT (SGLT1) is also found in the intestine and its inhibition reduces glucose levels mainly through delaying post-prandial hyperglycaemia (13).”
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Mechanisms of nephroprotective action of sodium–glucose cotransporter type 2 inhibitors
Росул, М. М., Блецкан, М. М., Ivano, N. V., & Korabelschykova, M. O. (2026) · Wiadomości Lekarskie · doi:10.36740/wlek/220827 · Cited by 1
“Consequently, SGLT-2 inhibitors provide a mild reduction in both fasting and postprandial glycemia [22].”
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“SGLT2 inhibitors represent a distinct class of orally administered antihyperglycemic agents whose therapeutic effect is based on the inhibition of glucose reabsorption in the proximal renal tubules, thereby promoting its urinary excretion 50,51 .”
Kawamura, T., Lee, T., Shintani‐Tachi, M., Terada, I., & Wakasugi, N. (2025) · Diabetes Therapy · doi:10.1007/s13300-025-01815-7 · Cited by 1
“Sodium‑glucose cotransporter 2 (SGLT2) inhibitors are a class of antidiabetic drugs that lower blood glucose levels by reducing glucose reabsorption in the kidneys [1].”
Comparative cardiovascular risks of canagliflozin and selective SGLT2 inhibitors in type 2 diabetes
Kornelius, E., Lo, S.-C., Yang, Y.-S., Wang, Y.-H., & Huang, C.-N. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1686851 · Cited by 1
“(Rieg and Vallon, 2018).”
Before you start: the safety of SGLT2 inhibitors for anti-obesity treatment
Meslamani, A. Z. A. (2025) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2025.2573368 · Cited by 2
“Its negative effects, especially those linked to intestinal SGLT1 inhibition, were explained by its nonselective activity, which also highlighted the need for more selective drugs with better effectiveness, safety, and bioavailability [32].”
Knowledge Mapping of SGLT2-Inhibitors and Cardiovascular Outcomes: A Bibliometric Analysis.
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“SGLT2i drugs include canagli fl ozin (Cana), empagli fl ozin, dapagli fl ozin, and ertugli fl ozin 12 .”
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“As antidiabetic agents, which was the primary indication, SGLT2is are modestly effective, but they proved to be exceptional in cardiac and renal protection 148–151 .”
Jiang, X., Yu, K.-S., Nam, D. H., & Oh, J. (2024) · Pharmaceuticals · doi:10.3390/ph17040522 · Cited by 1
“SGLT2 inhibitors, which were first developed in 2013, are a class of hypoglycemic agents that work by inhibiting glucose reabsorption in the kidneys, resulting in increased glucose excretion in the urine and decreased blood glucose levels [6].”
BackgroundEL‐Andari, R., Fialka, N. M., Kang, J. J. H., Bozso, S. J., Nagendran, J., & Nagendran, J. (2023) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-023-00618-0 · Cited by 1
“Maintenance of adequate glycemic control is multifactorial, with lifestyle modifications, insulin replacement, and oral antihyperglycemic agents playing a role in different circumstances [3–5].”
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“Thus, inhibiting SGLT1 in the small intestine can lead to a reduction in blood glucose levels, thereby providing a novel and effective approach to managing blood glucose levels in diabetic patients, hence improving long-term health outcomes (Dyer et al., 2002, Rieg & Vallon, 2018).”
Bogowska, M., Berner, A., MARCZYK, K., MATYJA, K., OLSZEWSKA, A., PĘKAŁA, M., Polak, P., POLASZEK, M., Stelmaszak, K., & Stencel, K. (2023) · Journal of Education Health and Sport · doi:10.12775/jehs.2023.38.01.013 · Cited by 1
“[1] Flozins, both in monotherapy and combined with glucosemoderating drugs profoundly maintain adequate level of glucose in the blood.”
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“T-1095 inhibits the activity of SGLT1 and SGLT2 in the kidney however, it showed some poor metabolic stability in preclinical trials and was abandoned [9].”
BackgroundMetformin use and the risk of anal intraepithelial neoplasia in type II diabetic patients
Hsu, A. T., Hung, Y.-C., Fang, S., D'Adamo, C., Mavanur, A., Svoboda, S., & Wolf, J. (2021) · Colorectal Disease · doi:10.1111/codi.15860 · Cited by 1
“SGLT2 inhibitors have been approved by the US Food and Drug Administration for clinical use since 2013 [20].”
BackgroundTherapeutic Approaches for Nonalcoholic Steatohepatitis ( NASH )
Glatthar, R., & Arch, R. H. (2021) · Wiley eBooks · doi:10.1002/0471266949.bmc274 · Cited by 1
Diabetic Kidney Disease Represents a Locus of Opportunity
Ecelbarger, C. M. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.650503 · Cited by 1
“The original aim of this drug class, as developed, was to design a safer drug with similar properties to Phlorizin (blocked both isoforms, but which had intestinal side effects) (Rieg and Vallon, 2018).”
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“The remaining glucose is reabsorbed via SGLT1 in ensuing nephron segments 13 .”
Armanni-Ebstein Lesions Associated With SGLT2 Inhibitor Therapy
Takahashi, M., Kaseda, R., Ito, Y., Imai, N., Kabasawa, H., Hosojima, M., Saito, A., & Yamamoto, S. (2026) · Kidney International Reports · doi:10.1016/j.ekir.2026.107152
SGLT2 inhibitors: mechanisms, physiology and pharmacology, and clinical applications
Zheng, X.-T., Xie, H.-Y., Wang, X.-H., Zhao, Y., Yang, J.-Y., Liu, Y.-X., Yuan, X.-L., Tang, H.-F., Jiang, Z., & Hu, H.-J. (2026) · Molecular Biomedicine · doi:10.1186/s43556-026-00604-3
“Under physiological conditions, SGLT2 is a low-affinity, high-capacity transporter located predominantly in the S1 and S2 segments of the renal proximal tubule, where it mediates most filtered glucose reabsorption [2, 90].”
InfluentialSun, X., Wang, L., Li, G., Zhang, H., Li, L., Xiang, G., Wang, T., Dong, L., Chen, J., & Wang, A. (2026) · American Journal of Therapeutics · doi:10.1097/mjt.0000000000002144
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Na/K-ATPase in the renal proximal tubule cell: classic & novel roles in sodium handling
Sklioutovskaya-Lopez, K., Islam, M. R., Mukherji, S. T., Strause, S., Crutchley, J., Sun, S., Pessoa, M. T., & Pierre, S. V. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1858622
“Highly specialized renal sodium transport systems (NKA, channels, cotransporters, and exchangers) have been cloned and characterized in each nephron segment, providing molecular insight and druggable targets (Ali et al., 2012; Rieg and Vallon, 2018).”
Lee, E., Han, K., Kwak, S., Hong, J. H., Hwang, Y.-C., Koh, G., Hughes, J. W., Kim, S., Lee, C.-S., & Cha, B.-S. (2026) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2025.1152
“However, when glucose delivery to the late proximal tubule is increased, such as in hyperglycemia or after SGLT2 inhibition, SGLT1 operates near its maximal transport capacity, making concurrent blockade more substantial [22].”
Reddy, N. M., Prasad, K. S., Reddy, N., Reddy, K., Kumari, G., & Mulakayala, N. (2026) · Asian Journal of Chemistry · doi:10.14233/ajchem.2026.36011
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Liu, Y. (2026) · Advances in Engineering Technology Research · doi:10.56028/aetr.17.1.1080.2026
“L cells actively take up glucose through sodium-glucose cotransporter 1 (SGLT1) expressed in the apical membrane, triggering membrane depolarization and calcium ion influx, triggering GLP-1 vesicle release(Rieg & Vallon, 2018).”
Lee, S. S., Kim, J., Lee, S. H., Kim, S., Bang, K.-H., & Yoo, Y. C. (2026) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2026.119400
Li, Z., Li, S.-H., Lv, X., & Li, F.-H. (2026) · Biology · doi:10.3390/biology15120956
Sohn, Y. J., & Bae, H. (2026) · Medicine · doi:10.1097/md.0000000000049129
“[21] Angiotensin II (Ang II), acting via AT 1 receptors, increases reactive oxygen species production, upregulates vascular and intercellular adhesion molecules (VCAM-1, ICAM-1), and promotes pro-inflammatory cytokine and chemokine synthesis.”
The Role of SGLT2 Inhibitors in the Management of Diabetic Retinopathy: A Literature Review.
Babović, S., Denda, N., Maletin, N., Kusturica, M., Zečević, D., & Rašković, A. (2026) · Pharmazie · doi:10.31083/pharmazie51803
Abdou, F. Y., Shibrya, E. E., Ali, M., Arafa, N. M., & Abdelaleem, R. M. A. (2026) · Archives of Medical Research · doi:10.1016/j.arcmed.2026.103438
Dapagliflozin induces renal lipidomic remodeling and systemic metabolic improvement
Li, A.-N., Ye, Y., Tang, J.-L., Hu, J., Shi, M.-Q., Wu, Y., Ji, C.-B., & Zhang, H. (2026) · Biology Direct · doi:10.1186/s13062-026-00800-9
“Beyond glycemic control, SGLT2is have garnered considerable attention for their pleiotropic effects, including well-documented cardiovascular and hepatic benefits [15–20].”
Pharmacokinetics of Bexagliflozin After Intravenous and Oral Administration in Cats
Patel, Y., Bhattarai, S., & Toutain, C. (2026) · Journal of Veterinary Pharmacology and Therapeutics · doi:10.1111/jvp.70072
“Sodium–glucose cotransporter 2 (SGLT2) inhibitors represent a significant advancement in the management of type 2 diabetes mellitus in humans (Scheen 2015; Rieg and Vallon 2018).”
Talyshinskii, A., Gauhar, V., Yuen, S. K. K., Güven, S., Tokas, T., Tsaturyan, A., Enikeev, D., & Somani, B. (2026) · Asian Journal of Urology · doi:10.1016/j.ajur.2025.11.004
“SGLT2 is responsible for glucose reabsorption from the nephron’s proximal tubule and is located almost exclusively in renal tissue [19].”
Kim, B.-J., & Song, K.-H. (2026) · Frontiers in Veterinary Science · doi:10.3389/fvets.2026.1791139
“By inhibiting proximal tubular glucose and sodium reabsorption, SGLT2i increase urinary glucose excretion and promote a mild natriuresis accompanied by osmotic diuresis (7, 8).”
InfluentialSjöholm, Å., & Rao, A. D. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1808396
“Inhibitors of SGLT2 thus reduce this reabsorption, which consequently leads to increased glucosuria and osmotic diuresis and thus better glycemic control, weight loss and slightly lower blood pressure (10, 11).”
Xiong, R., yang, Y., Li, Y., & Zhang, H. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1785329
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“This natural compound was the first agent discovered to competitively inhibit SGLT1 and SGLT2 [5,33].”
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“…the primary active transport of glucose and galactose across the intestinal epithelium [42]; mutations in the SGLT1 gene ( SLC5A1 ) can lead to glucose/galactose malabsorption [43], while GLUT2 defects (Fanconi–Bickel syndrome) impair glucose and galactose handling and may lead to intolerance [44].”
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Sodium-glucose cotransporter 1 inhibition may delay aging: a Mendelian randomization study
Fan, G., Qu, Z.-H., Zuo, H., & Zhou, W. (2025) · Archives of Medical Science · doi:10.5114/aoms/209208
“(2) The association between certain genetic polymorphisms in SGLT1 inhibitors and glycated hemoglobin (HbA 1c ) has been demonstrated [17].”
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Canagliflozin Inhibits Electrogenic Na+ Transport in Mouse Cortical Collecting Duct Cells
Nickerson, A. J., Albalawy, W. N., Youm, E. B., Joseph, N. A., Szekely, K. G., Kleyman, T., Weisz, O., & Kashlan, O. B. (2025) · Function · doi:10.1093/function/zqaf039
Sodium-glucose cotransporter-1 inhibition and depression: A Mendelian randomization study
Fan, G., Zuo, H., Shi, X.-G., & Liu, B. (2025) · SAGE Open Medicine · doi:10.1177/20503121251352618
Yu, B., Cui, Y., Lin, L.-Y., Wu, M., & Teng, J. (2025) · Biochemical and Biophysical Research Communications - BBRC · doi:10.1016/j.bbrc.2025.151399
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Metadata
- 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
- PMC
- PMC6124499
- 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
- bronze
- doi.org
- 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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