What next after metformin? Thinking beyond glycaemia: are SGLT2 inhibitors the answer?

Evans, Marc, Morgan, Angharad R. and Yousef, Zaheer 2019. What next after metformin? Thinking beyond glycaemia: are SGLT2 inhibitors the answer? Diabetes Therapy 10 (5) , pp. 1719-1731. 10.1007/s13300-019-00678-z

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Abstract

The prevalence of type 2 diabetes continues to increase, along with a proliferation of glucose-lowering treatment options. There is universal agreement in the clinical community for the use of metformin as the first-line glucose-lowering therapy for the majority of patients. However, controversy exists regarding the choice of second-line therapy once metformin is no longer effective. The most recent treatment consensus focuses on the presence of cardiovascular disease, heart failure or kidney disease as a determinant of therapy choice. The majority of patients in routine practice, however, do not fall into such categories. Heart failure and kidney disease represent significant clinical and cost considerations in patients with type 2 diabetes and have a close pathophysiological association. Recent data has illustrated that sodium-glucose transporter 2 (SGLT2) inhibitor therapy can reduce the burden of heart failure and the progression of renal disease across a wide range of patients including those with and without established disease, supported by an increased understanding of the mechanistic effects of these agents. Furthermore, there is growing evidence to illustrate the overall safety profile of this class of agents and support the benefit–risk profile of SGLT2 inhibitors as a preferred option following metformin monotherapy failure, with respect to both kidney disease progression and heart failure outcomes.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by-nc/4.0/, Type: open-access
Publisher:	Springer
ISSN:	1869-6953
Date of First Compliant Deposit:	27 August 2024
Last Modified:	27 Aug 2024 16:45
URI:	https://orca.cardiff.ac.uk/id/eprint/171595

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