SGLT2 inhibitors

Question 1

how was SGLT2i invented?

Answer 1

modified from phlorizin to increase oral bioavailability and to be specific for renal isoform (SGLT2)

Question 2

do SGLT2i increase or decrease sugar uptake?

Answer 2

decrease uptake of sugar by around a quarter

Question 3

what happens as a result of the decrease in sugar uptake?

Answer 3

you pee sugar!
leads to weight loss (eg. 80g of sugar a day=320 kcals per day=2500kcals lost in urine a week=1 lb per week weightloss)
weightloss does eventually plateau though

Question 4

what are the consequences of SGLT2i?

Answer 4

dieresis
improved myocardial energetics
renal protection

Question 5

how potent are SGLT2i?

Answer 5

moderate efficacy- around 11mmol/mol

Question 6

SGLT2i increase LDL and decrease HDL cholesterol-true or false?

Answer 6

false- increase both

Question 7

what are the common SGLT2i?

Answer 7

dapagliflozin
canagliflozin
empagliflozin

Question 8

what is the most commonly used SGLT2i in tayside?

Answer 8

empagliflozin (10mg od)

Question 9

what is the most common side effect of SGLT2i?

Answer 9

thrush secondary to glyosuria
10% of women and 4% of men
usually mild and treatable

Question 10

what is a rare side effect of SGLT2i?

Answer 10

fournier gangrene (15/100000 people per year)
diabetes ketoacidosis (double the risk of DPP4i)

Question 11

should SGLT2i be used in prolonged fasting or acute illness?

Answer 11

no

Question 12

do SGLT2i worsen CV status?

Answer 12

no
they have a large and unexpected CV benefit (38% reduction in CV death)

Question 13

do SLGT2i lead to better renal outcomes?

Answer 13

yes