SGLT2 inhibitors in T2D and associated comorbidities - differentiating within the class

• Published in: BMC endocrine disorders 2019-06, Vol.19 (1), p.64-13, Article 64
• Main Authors: Schernthaner, Guntram, Drexel, Heinz, Moshkovich, Evgeny, Zilaitiene, Birute, Martinka, Emil, Czupryniak, Leszek, Várkonyi, Tamás, Janež, Andrej, Ducena, Kristine, Lalić, Katarina, Tankova, Tsvetalina, Prázný, Martin, Smirčić Duvnjak, Lea, Sukhareva, Olga, Sourij, Harald
• Format: Article
• Language: English
• Subjects: Antidiabetics; Bias; Canagliflozin; Cardiac patients; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Clinical trials; Comorbidity; Complications and side effects; Correspondence; Dapagliflozin; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Dosage and administration; Drug therapy; Drugs; Empagliflozin; FDA approval; Glucose; Heart failure; Humans; Hypoglycemic agents; Incidence; Infections; Kidney diseases; Medical research; Meta-analysis; Mortality; Population; Prognosis; Retirement benefits; Risk factors; SGLT2 inhibitor; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Studies; Systematic review; Type 2 diabetes; Urogenital system
• ISSN: 1472-6823; 1472-6823
• DOI: 10.1186/s12902-019-0387-y

For patients with type 2 diabetes (T2D), cardiovascular disease (CVD) is the single most common cause of mortality. In 2008 and 2012, the Federal Drug Administration (FDA) and the European Medicines Agency (EMA) respectively mandated cardiovascular outcomes trials (CVOTs) on all new anti-diabetic agents, as prospective trials statistically powered to rule out excess cardiovascular risk in patients with T2D. Unexpectedly, some of these CVOTs have demonstrated not only cardiovascular safety, but also cardioprotective effects, as was first shown for the SGLT2 inhibitor empagliflozin in EMPA-REG OUTCOME. To debate newly available CVOT data and to put them into context, we convened as a group of medical experts from the Central and Eastern European Region. Here we describe our discussions, focusing on the conclusions we can draw from EMPA-REG OUTCOME and other SGLT2 inhibitor CVOTs, including when considered alongside real-world evidence. CVOTs investigating SGLT2 inhibitors have suggested benefits beyond glucose lowering that have been confirmed in real-world evidence studies.