Update on the efficacy and safety of sodium–glucose cotransporter 2 inhibitors in Asians and non‐Asians

Fujita, Yoshihito; Inagaki, Nobuya

doi:10.1111/jdi.13150

Cited by 12 publications

(7 citation statements)

References 15 publications

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“…The safety profile of SGLT2is has been extensively investigated and subject to huge discussion in recent years. 60 This safety profile appears to be very similar in Asian versus non-Asian patients, 61 as shown in pooled analyses of trials performed with dapagliflozin, 62 canagliflozin, 63 and empagliflozin, 64 including for empagliflozin in East Asian patients. 65 The overall safety profile of SGLT2is in East Asian patients with T2DM was comparable to that classically reported in non-Asian (Caucasian) patients: 2,60 SGLT2is did not increase the risk of hypoglycemia and urinary tract infections, but did increase the risk of mycotic genital tract infections.…”

Section: Discussionmentioning

confidence: 84%

<p>SGLT2 Inhibitors as Add-On Therapy to Metformin for People with Type 2 Diabetes: A Review of Placebo-Controlled Trials in Asian versus Non-Asian Patients</p>

Scheen

2020

DMSO

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Metformin remains the first pharmacological choice for treating hyperglycemia in type 2 diabetes (T2DM) in most international guidelines. Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) are increasingly used as add-on therapy. T2DM pathophysiology is different in Asian and non-Asian (mainly Caucasian) patients. The aim of this systematic review is to compare the efficacy of SGLT2is vs placebo added to metformin in randomized controlled trials (RCTs: range 12–52 weeks) in Asian versus non-Asian patients with T2DM. The primary endpoint is the reduction in glycated hemoglobin (HbA1c) from baseline and key secondary endpoints are reductions in fasting plasma glucose (FPG), body weight (BW) and systolic blood pressure (SBP). Systematic literature search collected 7 RCTs (3 with 2 doses) in Asian patients (10 analyses, n=1164, iSGLT2: canagliflozin, dapagliflozin, ertugliflozin, ipragliflozin, tofogliflozin)) and 10 RCTs (6 with two doses) in non-Asian patients (16 analyses, n=2482, iSGLT2: canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, ipragliflozin). Baseline values of HbA1c (7.98±0.19 vs 7.89±0.27%), FPG (8.80 ±0.46 vs 9.11±0.49 mmol/l) and SBP (128.4±1.6 vs 130.2±3.1 mmHg) were not significantly different in Asian vs non-Asian patients, but BW was lower in Asian patients (71.6±4.8 vs 88.0±2.5 kg, p<0.001). The placebo-adjusted weighed mean differences (WMD, 95% CI) were similar in Asian versus non-Asian patients regarding the reductions in HbA1c −0.60 (−0.68, −0.53) % versus −0.54 (−0.59, −0.49) % (p=0.568), FPG −1.37 (−1.53, −1.22) mmol/l vs −1.37 (−1.47, −1.27) mmol/l (p=0.627), BW when expressed in percentage of baseline BW −2.23 (−2.55, −1.90) % vs −2.16 (−2.37, −1.96) % (p=0.324), and SBP −4.53 (−5.53, −3.53) mmHg vs −4.06 (−4.83, −3.29) mmHg) (p=0.223). In conclusion, clinical efficacy of SGLT2i, as an add-on treatment to metformin monotherapy in patients with T2DM, is similar in Asian versus non-Asian patients, despite known ethnic differences in phenotype and pathophysiology of T2DM.

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Section: Discussionmentioning

confidence: 84%

<p>SGLT2 Inhibitors as Add-On Therapy to Metformin for People with Type 2 Diabetes: A Review of Placebo-Controlled Trials in Asian versus Non-Asian Patients</p>

Scheen

2020

DMSO

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“…SGLT2 inhibitors reduce plasma glucose concentration and body weight by inhibiting glucose absorption in the kidney. They also exert preventive effects on major adverse cardiovascular events, heart failure hospitalization, and progression of renal impairment (13). In contrast, several risks of using SGLT2 inhibitors have been reported, and the latest edition of "recommendations" updated in July 2019 declares safety concerns, such as diabetic ketoacidosis, especially when used in type 1 diabetic patients; hypoglycemia, when used with sulfonylurea or insulin; volume depletion; skin lesion; and urogenital infections.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of sodium-glucose cotransporter 2 inhibitor with glucagon-like peptide-1 receptor agonist for the glycemic control of a patient with Prader-Willi syndrome: a case report

Sano

Kudo

Yamazaki

et al. 2020

Clin Pediatr Endocrinol

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Prader-Willi syndrome (PWS) is often related to severe obesity and diabetes mellitus (DM). Clinical findings suggesting the benefits of glucagon-like peptide-1 (GLP-1) receptor agonists for glycemic control of DM in PWS have been recently increasing. However, there are only a few reports describing the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors for PWS. We present a diabetic female with PWS, whose glycemic control was deteriorated at the age of 19 but improved to a certain extent by introducing the GLP-1 analog liraglutide. At the age of 20, the SGLT2 inhibitor empagliflozin was administered. Subsequently, her HbA1c level and body weight markedly decreased. Improvement in both insulin resistance and secretion was observed during the subsequent six months. In addition to GLP-1 receptor agonists, SGLT2 inhibitors may be a potential approach for the management of DM in PWS, especially in young patients whose pancreatic insulin secretion capabilities are still preserved.

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“…Both the efficacy and the safety of SGLT2is were shown to be comparable in Asian populations and in White Europeans and White North Americans [96][97][98] . These findings allowed for researches to confirm the use of SGLT2is in patients with T2DM who originate from Asia 99 .…”

Section: Ethnicitymentioning

confidence: 99%

Sodium–glucose cotransporter type 2 inhibitors for the treatment of type 2 diabetes mellitus

Scheen

2020

Nat Rev Endocrinol

187

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The management of type 2 diabetes mellitus (T2DM) is becoming increasingly complex. Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) are the newest antidiabetic agents for T2DM. By targeting the kidney, they have a unique mechanism of action, which results in enhanced glucosuria, osmotic diuresis and natriuresis, thereby improving glucose control with a limited risk of hypoglycaemia and exerting additional positive effects such as weight loss and the lowering of blood pressure. Several outcome studies with canagliflozin, dapagliflozin or empagliflozin reported a statistically significant reduction in major cardiovascular events, hospitalization for heart failure and progression to advanced renal disease in patients with T2DM who have established atherosclerotic cardiovascular disease, several cardiovascular risk factors, albuminuric mild to moderate chronic kidney disease or heart failure. Current guidelines proposed a new paradigm in the management of T2DM, with a preferential place for SGLT2is, after metformin, in patients with atherosclerotic cardiovascular disease, heart failure and progressive kidney disease. Ongoing trials might extend the therapeutic potential of SGLT2is in patients with, but also without, T2DM. This Review provides an update of the current knowledge on SGLT2is, moving from their use as glucose-lowering medications to their new positioning as cardiovascular and renal protective agents.

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Update on the efficacy and safety of sodium–glucose cotransporter 2 inhibitors in Asians and non‐Asians

Abstract: Benefits and risks of SGLT2 inhibitor use.

Cited by 12 publications

References 15 publications

<p>SGLT2 Inhibitors as Add-On Therapy to Metformin for People with Type 2 Diabetes: A Review of Placebo-Controlled Trials in Asian versus Non-Asian Patients</p>

<p>SGLT2 Inhibitors as Add-On Therapy to Metformin for People with Type 2 Diabetes: A Review of Placebo-Controlled Trials in Asian versus Non-Asian Patients</p>

Efficacy of sodium-glucose cotransporter 2 inhibitor with glucagon-like peptide-1 receptor agonist for the glycemic control of a patient with Prader-Willi syndrome: a case report

Sodium–glucose cotransporter type 2 inhibitors for the treatment of type 2 diabetes mellitus

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