Guide Health: Diabetes drugs aren’t just for diabetes any more

This new class of diabetes drugs called SGLT-2 inhibitors may boost your heart health as well

One of the newer classes of diabetes drugs seem to be advertised for not just diabetes, but cardiovascular health as well, and indeed research has shown this to be valid.

The class is the SGLT-2 inhibitors, that is Sodium GLucose coTransporter-2 inhibitors. They act by inhibiting this transport protein in order to prevent glucose re-absorption by the kidney.

The result is that more glucose is excreted through the kidney, lowering blood glucose levels, which is the aim of drug treatment for diabetes.

SGLT-2 inhibitor drugs include canagliflozin, dapagliflozin and empagliflozin.

These drugs improve outcomes in heart failure, also known as HF. Just as the term indicates, heart failure happens when the heart muscle doesn’t pump as it should. Narrowing coronary blood vessels or high blood pressure may account for the failure.

The left ventricle that pumps oxygenated blood to all parts of the body, and the “ejection fraction” is the measure of the amount of blood pumped with each of its contractions.

The ventricle can become enlarged and unable to pump efficiently, which is termed reduced ejection fraction or HFrEF.

Another type of heart failure occurs with preserved ejection fraction or HFpEF and is the result of the left ventricle becoming thicker and stiffer.

In several studies, researchers added a SGLT-2 inhibitor to the medication regimes of people with and without diabetes. In both groups the addition of the drug helped prevent hospitalizations and cardiovascular death about three to seven per cent of the time. It is thought that besides lowering blood glucose, these drugs contribute to lower blood pressures, to reduced blood vessel stiffness, and even to diuretic effects.

SGLT-2 inhibitors have these effects in HFrEF, which accounts for about half of all cases of heart failure.

When kidney disease is considered, these drugs can also be beneficial. They protect the nephrons which are the functional units of the kidneys.

Studies show that by adding a SGLT-2 inhibitor to a medication regime, progression of kidney disease can be slowed for people with or without diabetes.

Unfortunately, because the SGLT-2 inhibitors rely on the kidneys to excrete excess glucose, the beneficial effects are lost when kidney functioning becomes low, and these drugs are not recommended. Ideally, they are used earlier in kidney disease and can be of benefit regardless of whether there is a diagnosis of diabetes or not.

For people with diabetes, specifically type 2 diabetes, SGLT-2 inhibitors are an ideal add-on to treatment, along with dosage adjustments for other diabetes medications. It is estimated that under 50 per cent of people with diabetes adhere to their medication regime and lifestyle recommendations, thus remembering to take medications including the SGLT-2 inhibitors is key.

Currently, these medications may not be used widely except in cases of diabetes. However, this may change in the future.

In the meantime, individuals with or without diabetes need to maximize both medication regimes and lifestyle activities in order to stay as healthy as possible.

About the author

Contributor

Marie Berry is a lawyer/pharmacist interested in health and education.

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