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A real-world experience of a prescribing policy for SGLT2-inhibitors in HFrEF in a Malaysian public tertiary cardiac centre

Yong VS, Yen CH, Saharudin S, Tan SL, Kaukiah NF, Liew HB

Med J Malaysia, 2024 Mar;79(2):237-239.
PMID: 38553932

A prescribing policy for SGLT2-inhibitors was implemented in a local public tertiary cardiology centre in Sabah to improve access for heart failure (HF) patients. The study evaluated 169 HF patients with reduced ejection fraction (HFrEF) who met the policy criteria. After starting SGLT2- inhibitors, a significant proportion of patients experienced decreased NTproBNP levels, indicating a positive response. HF hospitalisation rates within 1 year were lower compared to the previous year. No adverse events were reported, suggesting that the treatment is safe. Findings demonstrates the benefits of implementing prescribing policies to enhance treatment accessibility and generate valuable real-world data at the local healthcare level..

Matched MeSH terms: Sodium-Glucose Transporter 2
Systematic review of metformin monotherapy and dual therapy with sodium glucose co-transporter 2 inhibitor (SGLT-2) in treatment of type 2 diabetes mellitus

Molugulu N, Yee LS, Ye YT, Khee TC, Nie LZ, Yee NJ, et al.

Diabetes Res Clin Pract, 2017 Oct;132:157-168.
PMID: 28797524 DOI: 10.1016/j.diabres.2017.07.025

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) is a chronic disorder and its treatment with only metformin often does not provide optimum glycemic control. Addition of sodium glucose cotransporter 2 inhibitor (SGLT2) will improve the glycemic control in patients on metformin alone. In this study, an attempt is made to investigate the combined therapy of SGLT-2 with metformin in managing T2DM in terms of lowering HbA1c and body weight and monotherapy using metformin alone in HbA1c and body weight reduction.
OBJECTIVES: To compare the clinical effectiveness of combined therapy using SGLT2 inhibitor and metformin with monotherapy using metformin alone in HbA1c and body weight reduction.
METHOD: A systematic review of the randomized controlled trials has been carried out and Cochrane risk of bias tool was used for the quality assessment. Patient, Intervention, Comparison and Outcomes (PICO) technique is used to select the relevant articles to meet the objective.
RESULTS: The studies used in this article are multicenter, double-blinded randomized controlled trials on SGLT2 inhibitors with methformin, there were a total of 3897 participants, with a range of 182 to 1186 individual study size were included. Studies showed that combined therapy were more effective in HbA1c and body weight reduction as compared to monotherapy.
CONCLUSION: The combined therapy of SGLT2 inhibitor along with metformin is more effective in HbA1c reduction and weight reduction as compared to monotherapy using metformin alone. Among the three SGLT2 inhibitors such as dapagliflozin canagliflozin and empagliflozin do not differ much in the efficiency of weight reduction. However, Empagliflozin 25mg is effective in HbA1c reduction.

Matched MeSH terms: Sodium-Glucose Transporter 2/pharmacology; Sodium-Glucose Transporter 2/therapeutic use*
Fulltext Sodium-Glucose Co-transporter 2 Inhibitors in Heart Failure: Recent Data and Implications for Practice

Rosano G, Quek D, Martínez F

Card Fail Rev, 2020 Mar;6:e31.
PMID: 33294215 DOI: 10.15420/cfr.2020.23

Heart failure is a shared chronic phase of many cardiac diseases and its prevalence is on the rise globally. Previous large-scale cardiovascular outcomes trials of sodium.glucose co-transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes (T2D) have suggested that these agents may help to prevent primary and secondary hospitalisation due to heart failure and cardiovascular death in these patients. Data from the Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure (DAPA-HF) and Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction (EMPEROR-Reduced) have demonstrated the positive clinical impact of SGLT2 inhibition in patients with heart failure with reduced ejection fraction both with and without T2D. These data have led to the approval of dapagliflozin for the treatment of patients with heart failure with reduced ejection fraction, irrespective of T2D status. This article reviews the latest data reported from the DAPA-HF and EMPEROR-Reduced trials and their clinical implications for the treatment of patients with heart failure.

Matched MeSH terms: Sodium-Glucose Transporter 2
Treatment Options for Patients with Type 2 Diabetes Mellitus during the Fasting Month of Ramadan

Loh HH, Kamaruddin NA

Ann Acad Med Singap, 2020 Jul;49(7):468-476.
PMID: 33000110

During Ramadan, Muslims fast from sunrise (Sahur) to sunset (Iftar) and are required to abstain from food and fluids, including oral and injectable medications. Patients with diabetes who fast during Ramadan are at risk of developing hyperglycemia with increased risk of ketoacidosis, hypoglycemia, dehydration and thrombosis. Pre-Ramadan education and preparation of a fasting patient are essential to reduce severe complications. This review paper summarizes studies to date on oral and injectable medications available for patients with type 2 diabetes during Ramadan fasting, as well as recommendations on management of these patients during Ramadan. Although there is limited data on the use of Metformin, Acarbose and Thiazolidinedione in Ramadan, they appear to be safe. Sulphonylurea, especially Glibenclamide, is associated with higher risk of hypoglycemia during Ramadan fasting, hence may need adjustment in dosing and timing. The incretin group and SGLT2 inhibitor use during Ramadan fasting is associated with low risk of hypoglycemia with no increased adverse events. Insulin regimes need to be individualized for patients who fast during Ramadan.

Matched MeSH terms: Sodium-Glucose Transporter 2
Gneyulins A and B, stilbene trimers, and noidesols A and B, dihydroflavonol-C-glucosides, from the bark of Gnetum gnemonoides

Shimokawa Y, Akao Y, Hirasawa Y, Awang K, Hadi AH, Sato S, et al.

J Nat Prod, 2010 Apr 23;73(4):763-7.
PMID: 20192242 DOI: 10.1021/np9007987

Gneyulins A (1) and B (2), two new stilbene trimers consisting of oxyresveratrol constituent units, and noidesols A (3) and B (4), two new dihydroflavonol-C-glucosides, were isolated from the bark of Gnetum gnemonoides. The structures and configurations of 1-4 were elucidated on the basis of 2D NMR correlations and X-ray analysis. Gneyulins A (1) and B (2) showed inhibition of Na(+)-glucose transporters (SGLT-1 and SGLT-2).

Matched MeSH terms: Sodium-Glucose Transporter 2/antagonists & inhibitors
Place of sodium-glucose cotransporter-2 inhibitors in East Asian subjects with type 2 diabetes mellitus: Insights into the management of Asian phenotype

Lim LL, Tan AT, Moses K, Rajadhyaksha V, Chan SP

J Diabetes Complications, 2017 Feb;31(2):494-503.
PMID: 27866701 DOI: 10.1016/j.jdiacomp.2016.10.008

The burden of type 2 diabetes (T2DM) in East Asia is alarming. Rapid modernization and urbanization have led to major lifestyle changes and a tremendous increase in the prevalence of obesity, metabolic syndrome, and diabetes mellitus. The development of T2DM at a younger age, with lower body mass index, higher visceral adiposity, and more significant pancreatic beta-cell dysfunction compared to Caucasians are factors responsible for the increased prevalence of T2DM in East Asians. Sodium-glucose Cotransporter-2 (SGLT2) inhibitors (canagliflozin, dapaglifozin, empagliflozin, etc.) reduce renal glucose reabsorption, leading to favorable effects on glycemic, blood pressure, and weight control. The insulin-independent mechanism enables their use as monotherapy or combination therapy with insulin and other oral antidiabetic agents. The role of SGLT2 inhibitors in the management of T2DM among East Asians is an interesting area of research, given that East Asians have been proven to be uniquely different from Caucasians. This review provides comprehensive coverage of the available literature not only on the efficacy and safety, but also on the recent cardiovascular and renal outcomes of SGLT2 inhibitors, focusing among East Asians.

Matched MeSH terms: Sodium-Glucose Transporter 2/metabolism
Canagliflozin in Asian patients with type 2 diabetes on metformin alone or metformin in combination with sulphonylurea

Ji L, Han P, Liu Y, Yang G, Dieu Van NK, Vijapurkar U, et al.

Diabetes Obes Metab, 2015 Jan;17(1):23-31.
PMID: 25175734 DOI: 10.1111/dom.12385

To evaluate the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in Asian patients with type 2 diabetes mellitus (T2DM) inadequately controlled by metformin or metformin in combination with sulphonylurea.

Matched MeSH terms: Sodium-Glucose Transporter 2/antagonists & inhibitors*