Not only lowers blood sugar and protects the heart and kidneys! Is "blockbuster drug" SGLT-2 inhibitor expected to treat gout in the future?
Diabetes can cause changes in the body’s large and small blood vessels, leading to complications such as cardiovascular disease and chronic kidney disease, resulting in increased risk of disability and mortality. Among the emerging treatments for diabetes, SGLT-2 inhibitors inhibit urinary glucose reabsorption to increase renal glucose excretion. In recent years, SGLT-2 has been found to be helpful in the prevention of cardiovascular disease and the treatment of heart failure, and can also be used in patients with chronic kidney disease. Provides powerful protective benefits for heart and kidney function. In the future, it may even be used in rheumatic and immune diseases such as gout and lupus erythematosus, which has great therapeutic potential.
Inhibit blood sugar reabsorption! The hypoglycemic advantages of SGLT-2 inhibitors
The kidneys play an important role in regulating blood sugar. There are two types of sodium-glucose co-transporter receptors (SGLT receptors) in the human kidney. The second type “SGLT2 receptor” is responsible for absorbing nearly 90% of glucose and reabsorbing it. Back into the blood, SGLT-2 inhibitors (type 2 sodium-glucose co-transporter inhibitors) act on the proximal renal tubule to inhibit the reabsorption of glucose filtered by the glomerulus and promote the excretion of sugar in the urine. .
SGLT-2 inhibitors can reduce glycated hemoglobin (A1C) without increasing insulin and inhibiting insulin counter-regulatory responses, so they are less prone to the risk of hypoglycemia. In addition, they are less likely to lower blood pressure and weight, which are also clinical advantages. . In large trials, SGLT-2 helped reduce the risk of cardiovascular death by 38% and the risk of diabetic kidney disease by 39% in diabetic patients with a history of cardiovascular disease. For people with diabetes who are at risk for cardiovascular events and renal function, the organ-protective effects of SGLT-2 inhibitors should be considered as a priority.
Excrete sugar and reduce heart failure! Therapeutic benefits of SGLT-2 inhibitors
SGLT-2 inhibitors were originally used to treat type 2 diabetes, including canagliflozin, dapagliflozin, empagliflozin and ertugliflozin. They have also been proven to have cardiovascular and renal protective effects and can be used to protect organs in patients with chronic kidney disease (CKD). function, reducing the risk of heart failure in patients with kidney disease by 34%. However, attention should be paid to discontinuation of medication and diabetic ketoacidemia before surgery. Possible side effects also include risk of fractures, urinary tract infections, dehydration, low blood pressure, and increased LDL cholesterol.
In addition, diabetes is an important risk factor for heart failure, and SGLT-2 inhibitors have glucose excretion, natriuresis, and promote vasodilation, which can reduce atrial dilation, inflammation, sympathetic overexcitation, and reduce the risk of arrhythmia. Multiple trials have found that SGLT-2 inhibitors can reduce heart failure hospitalizations and cardiovascular mortality regardless of diabetes.
SGLT-2 inhibitors have multiple cardiac benefits and can reduce diuretic use in patients with heart failure. Taiwan currently has different SGLT2 inhibitor drugs approved for the treatment of heart failure or chronic kidney disease.
Lower uric acid and reduce the occurrence of gout? Future trends in SGLT-2 drug application
After the advent of SGLT-2 inhibitors, they have not only been used as a powerful tool in the treatment of diabetes, but have also successively shown protective effects on important organs such as the heart and kidneys. They are expected to continue to play an important role in the field of chronic disease care and are known as “heavy blockbusters”. drug". Because SGLT-2 inhibitors have potential anti-inflammatory and blood pressure-lowering effects, whether they have the opportunity to become a treatment option for rheumatic immune diseases has also become the focus of research in recent years.
A 2020 study on adults with diabetes showed that the use of SGLT-2 inhibitors can reduce the risk of gout by 36%. Taiwan has also released a similar study pointing out that compared with DPP-4 inhibitors, SGLT-2 has a reduced risk of gout. 11%. In a small case study in 2023, 43.5% of patients using SGLT-2 inhibitors reduced uric acid to less than 6 mg/dL.
In addition, some studies have shown that the use of SGLT-2 inhibitors in patients with systemic lupus erythematosus can reduce the deterioration of glomerular filtration rate, but there is no unanimous conclusion yet. The use of SGLT-2 in patients with rheumatic immune diseases should still be based on whether they meet the requirements. Indications. It is worth considering that chronic kidney disease and cardiovascular and cerebrovascular diseases are important factors causing disability, disability and premature death. Whether SGLT-2 inhibitors can simplify the medication of patients with rheumatic immune diseases and avoid more deaths and medical expenses is urgent. Expected.
