Sodium glucose co-transporter 2 inhibitors: a novel approach to the management of type 2 diabetes mellitus.

PURPOSE: The purpose of this article is to educate nurse practitioners about the newest class of oral medications developed to treat type 2 diabetes mellitus (T2DM). This article will review dapagliflozin and canagliflozin, the two Food and Drug Administration (FDA) approved sodium glucose co-transporter 2 (SGLT2) inhibitors, and discuss their place in therapy.

DATA SOURCES: A comprehensive literature search was conducted using MEDLINE with the key terms: dapagliflozin, canagliflozin, SGLT2 inhibitors, and SGLT2 inhibitors. Other resources included the World Health Organization (WHO), U.S. FDA, Centers for Disease Control and Prevention (CDC), clinical guidelines, FDA labeling, briefings, and press releases.

CONCLUSIONS

Dapagliflozin and canagliflozin appear to be safe and moderately effective. SGLT2 inhibitors provide an alternative for dual and triple therapy for T2DM or can be used as monotherapy in patients who cannot tolerate other first-line options.

IMPLICATIONS FOR PRACTICE: SGLT2 inhibitors have a unique, insulin-independent mechanism of action, targeting the kidneys. They have a low incidence of hypoglycemia and result in a moderate reduction in HbA1C. Improvements in weight, blood pressure, and lipid parameters have been demonstrated. Dosing considerations are required for the elderly, renally impaired, and patients at risk for hypotension.