The New and Evolving Roles of Sodium Glucose Co-Transporter 2 Inhibitors

Over the last five years there has been an increasing number of clinical trials demonstrating improved outcomes for sodium glucose co-transporter 2 inhibitors beyond improvements in glycemic control. The cardiovascular safety studies with empagliflozin, canagliflozin, and dapagliflozin showed varying degrees of improved cardiovascular outcomes in patients with type 2 diabetes and established cardiovascular disease or at high risk for such but each showed a reduction in heart failure admissions in this population. These studies also showed an improvement in renal outcomes. In 2019 canagliflozin demonstrated a reduction in the progression of diabetic kidney disease in patients with type 2 diabetes and existing nephropathy leading to the first new indication for the treatment of diabetic kidney disease in nearly two decades. Recently, dapagliflozin has shown to reduce cardiovascular death or heart failure admissions in patients with heart failure with reduced ejection fraction with or without the presence of diabetes.