Diabetes mellitus: SGLT-2 inhibitors reduce mortality

The lifestyle of the "civilized society" promotes the emergence of Diabetes mellitus Type 2. At the same time, overeating and inactivity increase the risk of cardiovascular disease

Who Heart attack, Stroke or peripheral arterial circulatory disorder.

The share of Diabetes mellitus, and especially "adult diabetes" (diabetes mellitus type 2, DM2), is increasing enormously worldwide.

The term "diabetes mellitus" comes from the Greek and means "honey-sweet flow". In ancient times, blood sugar was not measured, but the Diagnosis "Glucosuria" via urine. Glucosuria refers to the increased excretion of glucose via the urine by the kidneys. Today, diabetes mellitus is diagnosed, which defines the increase in blood sugar.

Glucose metabolism

Glucose is the human body's most important source of energy. On average, we need around 200 g of glucose per day when resting, 75% of which is used by the brain alone. Glucose is taken in with food and can either be processed immediately or stored as glycogen with the help of insulin in "glycogen synthesis" and used when needed. In addition, the body produces glucose itself to generate energy through "gluconeogenesis".

The kidneys produce around 180 litres of primary urine per day, which they filter and in this way reabsorb many substrates in the renal vascular network. However, only two litres of urine are excreted daily because most of the valuable products are "used". This includes glucose as an important energy source for most organs.

It is not uncommon for the body to not utilize glucose sufficiently due to overconsumption of carbohydrates and sugar or due to reduced insulin secretion by the pancreas. This causes the proportion of glucose in the blood to increase in the short term. If blood sugar levels are elevated for a longer period of time, glucose can be found in the urine because the kidneys can no longer compensate adequately. This leads to a "special reaction" in which the body tries to dispose of the increased sugar via the kidneys - glucosuria occurs.

Sodium glucose transporter (SGLT-2)

Normally, a so-called transporter (specifically the "SGLT-2 transporter") in the kidney area ensures that more than 90 percent of the glucose is reabsorbed. However, in the case of a chronic increase in glucose levels, the body wants to prevent too much loss. This means that in people with diabetes who have increased glucose in their primary urine, significantly more glucose is reabsorbed than usual. However, this means that more glucose is introduced into the blood system than in healthy people, which causes or worsens hyperglycemia (too high blood sugar).

Dispose of glucose via urine - drugs to inhibit transporters

It has long been known that the active ingredient phlorizin can lead to significant glucosuria. The loss of glucose via the kidneys normalized the glucose levels in the blood. This also led to an improvement in insulin effectiveness. However, phlorizin therapy was toxic and therefore not suitable for therapeutic use for a long time.

SGLT-2 inhibitors

In the meantime, however, drugs have been developed that selectively and reversibly inhibit the SGLT-2 transporter. Drugs from this family have now been in clinical use for some time and have proven to be safe.

SGLT2 inhibitors cause a drop in glucose in people with diabetes because a portion of the glucose is excreted via the kidneys and thus removed from the system. At the same time, there is another "positive side effect" because the loss of glucose also leads to a loss of calories, which also causes a slight weight loss. Other advantages are: a simultaneous reduction in blood pressure and no more hypoglycemia.

Hopeful study results

Studies have shown that SGLT-2 inhibitors have the following positive effects:

• lower cardiovascular risk
• reduction of mortality
• antihyperglycemic intervention
• significant reduction in hospitalization in heart failure
• significant and early improvement in kidney function.

The mechanisms that are now seen in all studies with SGLT2 inhibitors are still unclear; sodium loss occurs, energy metabolism may also improve, but many questions are still unanswered.

When choosing a diabetes medication, not only the effect on blood sugar levels and the side effect profile should play a role, but above all whether mortality is also reduced. SGLT2 inhibitors reduce mortality by 20%.

Conclusion: SGTL-2 inhibitors such as dapagliflozin and empagliflozin ensure that more glucose is excreted in the urine. This lowers blood sugar levels and - even more importantly - also mortality.

Special consultation for patients with diabetes mellitus type 2