Handbook of Insulin Therapies by Winston Crasto Janet Jarvis & Melanie J. Davies

Author:Winston Crasto, Janet Jarvis & Melanie J. Davies
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

4.3.3.3 Insulin in Combination with SGLT2 Inhibitors

SGLT2 inhibitors are novel oral glucose-lowering agents used in the management of individuals with T2DM. They reduce tubular reabsorption of glucose by selective, reversible inhibition of SGLT2 proteins which are expressed in the renal tubule, resulting in urinary loss of glucose. The clinical effects of SGLT2 inhibition, which is independent of insulin stimulation, result in improvements in glycemic control, lower risk of hypoglycemia, and weight loss. Modest reductions in blood pressure are also observed due to a natriuretic effect.

SGLT2 inhibitors in combination with insulin may provide additional glycemic benefits, may mitigate weight gain, and have been shown to be a useful adjunct to insulin therapy. Trials with SLGT2 inhibitors such as dapagliflozin, canagliflozin, and empagliflozin as an add-on to basal insulin have shown glycemic improvement without increased risk of hypoglycemia (Table 4.6) [36–39]. For example, in the EMPA-REG multiple daily injections (MDI) of insulin study, add-on empagliflozin therapy in obese individuals with inadequate glycemic control despite using high-dose MDI insulin showed greater improvements in glycemic control without an increased risk of hypoglycemia [39]. The results demonstrate that SGLT2 inhibitors are a safe and attractive option in individuals who fail to achieve HbA1c targets despite using more physiological insulin regimen.Table 4.6Selected trials illustrating glycemic efficacy and safety of insulin added to novel glucose-lowering drugs: SGLT2 inhibitors

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