The novel role of the kidney in diabetes management: Sodium-glucose co-transporter 2 inhibitors

The global epidemic of diabetes continues to progress, despite efforts of public health agencies and health care systems to identify and treat impacted patients. Although lifestyle is the cornerstone of treatment, there is an array of pharmacologic agents now available, many in classes that did not exist a few years ago. In addition to insulin and its secretogogues, such as sulfonylureas, there are agents that improve insulin action, reduce gastric emptying, reduce glucagon concentrations, and sympathetic nervous system activity. A novel class recently entering the fray includes drugs that interfere with renal glucose reabsorption. These drugs, collectively called sodium-glucose co-transporter 2 (SGLT2) inhibitors, are available both as single agents and in various combinations. They work by promoting glycosuria and may have benefits that extend beyond lowering glycemia, such as weight loss and blood pressure reduction. This review focuses on several of these new agents and considers their efficacy and potential side effects. We address drugs approved for use in the United States at the time of this writing (March, 2015), but do not address recently approved combination agents.