SGLT2 INHIBITION:

A NOVEL TREATMENT

STRATEGY FOR TYPE 2 DIABETES

MELLITUS

SGLT2 INHIBITOR: WHERE DO THEY FIT IN THE TREATMENT ALGORITHM

●Monotherapy●Add-on to: MET, SU, PIO●Add-on to oral combo therapy●Double/Triple combo therapy ●Add-on to insulin in T2DM●Add-on to insulin in T1DM● IGT/IFG●A1c > 10.0%

SGLT 2 INHIBITION: MEETING UNMETNEEDS IN DIABETES CARE

Corrects a Novel Pathophysiologic

Defect

ReducesHbA1c

Promotes Weight Loss

ComplementsAction of Other

AntidiabeticAgents

Reduces Blood

Pressure NoHypoglycemia

Improves GlycemicControl

and CVRFs

Reversal ofGlucotoxicity

GLP1TZDs

GLP1

GLP1HYPERGLYCEMI

AHYPERGLYCEMI

A

DecreasedIncretin Effect

DecreasedIncretin Effect

Decreased InsulinSecretion

IncreasedHGP

Islet– a cell

IncreasedGlucagonSecretion

OMINOUS OCTET

IncreasedLipolysis

IncreasedGlucose

Reabsorption

NeurotransmitterDysfunction

TZDs

GLP1

TZDsGLP1

TZDsMETGLP1

Decreased Glucose

Uptake

EXENATIDEAND NO HYPO USED WITH NO SU

EXENATIDE

Always try GLP-1 RA before Insulin

PATHOPHYSIOLOGIC-BASED (DEFRONZO) ALGORITHM

Lifestyle +TRIPLE COMBINATION:

PIO + Metformin + GLP-1 Analogue

HbA1c < 6.0%

Insulin use ben/risk