Cardiometabolic effects of a new class of antidiabetic agents
Open accessAbstract
Purpose Within the past decade, many new classes of drugs have received approval from the US Food and Drug Administration for treatment of type 2 diabetes mellitus, including glucagon-like peptide-1agonists, dipeptidyl peptidase-4 inhibitors, and the sodium-glucose cotransporter-2 inhibitors. Many trials have been performed, and several more are currently ongoing to evaluate these drugs. This review addresses the broad therapeutic and pleiotropic effects of these drugs. The review also discusses the role of these drugs in the treatment paradigm for type 2 diabetes and identifies patients who would be suitable candidates for treatment with these drugs.Methods In this comprehensive evidence-based review, the following databases were searched from 1990 to the present: PubMed/MEDLINE, Scopus, CINAHL, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Portal, and the American Diabetes Association and European Association for the Study of Diabetes abstract databases. Randomized clinical trials (RCTs) were only included for the main therapeutic and cardiovascular (CV) effects of these drug classes. For pleiotropic effects, RCTs were included unless no RCTs exist, in which case other studies as specified in the detailed Methods section were included.Findings All 3 drug classes are effective in lowering hemoglobin A1c between 0.4% and 1.4%, depending on the drug class and population selected. These drug classes have beneficial effects on CV risk factors, such as weight, lipids, and blood pressure, in addition to lowering blood glucose levels. The CV tolerability of some drugs has been evaluated and found to be neutral; however, most trials are currently ongoing to assess CV tolerability. There are no concrete guidelines to determine where these drugs fit in the diabetes management paradigm, and there are ongoing trials to determine the best combination drug with metformin.Implications These 3 drug classes will potentially increase the armamentarium against hyperglycemia. However, the specific combinations with other antidiabetic drugs and populations that will best benefit from these drugs are still being tested. Future research is also being conducted on the use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors in patients with type 1 diabetes.
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Precipitating factors leading to SGLT2 inhibitor-associated DKA include insulin reduction, omission, or deficiency along with surgery, alcohol abuse, exercise, and low-carbohydrate diets.
“Precipitating factors leading to SGLT2 inhibitor-associated DKA include insulin reduction, omission, or deficiency along with surgery, alcohol abuse, exercise, and low-carbohydrate diets. 1 , 7”
From Euglycemic Diabetic Ketoacidosis Caused by SGLT2 Inhibitors and a Ketogenic Diet: A Case Series and Review of Literature (2021) · cites this paper as [7]
The SGLT-2 INHIBITORS and Safety Profile and Adverse Effects sections (page numbers unavailable) discuss insulin-independent action and other adverse effects, but do not address DKA precipitants. Searches for DKA, insulin reduction, surgery, alcohol, exercise, and low-carbohydrate diets found no passage supporting the attributed list. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe duration of treatment with an SGLT2 inhibitor before the onset of DKA varies in reports from 0.3 to 420 days.
“The duration of treatment with an SGLT2 inhibitor before the onset of DKA varies in reports from 0.3 to 420 days. 7”
From Euglycemic Diabetic Ketoacidosis Caused by SGLT2 Inhibitors and a Ketogenic Diet: A Case Series and Review of Literature (2021) · cites this paper as [7]
The Safety Profile and Adverse Effects section discusses infections and volume depletion with SGLT-2 inhibitors, but not DKA onset. Searches for “0.3 to 420 days,” “ketoacidosis onset,” and “diabetic ketoacidosis” found no passage in our copy reporting the claimed treatment-duration range. (LLM, conf=0.76)
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Flagged first, then by citations
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An update on sodium-glucose co-transporter-2 inhibitors for the treatment of diabetes mellitus
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- Authors
- Desouza, C. V., Gupta, N., & Patel, A.
- Affiliations
- Omaha VA Medical Center (US)
- University of Nebraska Medical Center (US)
- Venue
- Clinical Therapeutics
- Publisher
- Elsevier BV
- Published
- 2015-06
- Volume
- 37
- Issue
- 6
- Pages
- 1178-1194
- ISSN
- 0149-2918 (ISSN-L)
- OpenAlex
- W2073935789
- Semantic Scholar
- 78a02b56fec7c659d2b60a15b27a6e357ab4b401
- Cited by
- 54
- References
- 97
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 3 · 2022: 10 · 2021: 11 · 2020: 6 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 6 · 2015: 3
- FWCI
- 0.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- type 2 diabetes, GLP-1 receptor agonists, DPP-4 inhibitors, SGLT2 inhibitors, cardiometabolic effects, cardiovascular risk factors, HbA1c, drug tolerability, metformin combination therapy, type 1 diabetes, pleiotropy
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Blood Glucose, Blood Pressure, Body Weight, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Glucagon-Like Peptide 1, Dipeptidyl-Peptidase IV Inhibitors
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