Role of SGLT2 inhibitors beyond diabetes care to metabolic care: Indian Perspective

The study revealed that sodium-glucose co-transporter 2 (SGLT2) inhibitors, with their several pleiotropic benefits, have received considerable attention recently as a novel class of antihyperglycaemic agents (AHAs) for diabetes management.

"SGLT2 inhibitors play an important role in the transition from glycemic control to metabolic care, specifically in the context of cardiovascular disease, obesity, and renal disease," Preet Lakhani, Medical Affairs, Johnson & Johnson Private Limited, Mumbai, Maharashtra, India, and colleagues wrote in their study. "In addition to improving glycemic control, SGLT2 inhibitors have been shown to reduce blood pressure, promote weight loss, and improve lipid profiles, which are key components of metabolic health."

SGLT2 inhibitors have demonstrated renal protective effects, including a slower decline in the estimated glomerular filtration rate (eGFR) and a reduction in albuminuria, suggesting a potential role in managing renal dysfunction.

There is a rise in the burden and prevalence of diabetes in India, making it ‘the diabetes capital of the world’. Comorbidities such as chronic kidney disease (CKD), cardiovascular (CV) complications, non-alcoholic fatty liver disease (NAFLD), neurodegenerative diseases, and obesity are common in patients with diabetes.

Recent breakthroughs in continuous glucose monitoring and diabetes medications have resulted in a paradigm shift in diabetes care. Hence, a review is warranted in the Indian context.

The review focuses on the evidence (gathered through a systematic literature search using online databases) on the cardio-renoprotective, metabolic, and hepatoprotective effects of SGLT2 inhibition, particularly in the Indian setting.

In conclusion, the transition from diabetes care to metabolic care represents a paradigm shift the metabolic disorders management. By taking a comprehensive approach that targets the underlying pathophysiology and addressing the multiple metabolic abnormalities associated with these disorders, metabolic care has the potential to improve outcomes and reduce the risk of complications.

The study further adds, "By addressing not only diabetes but also other comorbidities such as NAFLD, obesity, CVD, hypertension, and DKD, metabolic care aims to improve patient outcomes and reduce CVD risk. Implementing personalized and evidence-based interventions, including pharmacotherapy and lifestyle modifications, can help achieve optimal metabolic control and prevent the development of complications."

"This shift requires a more patient-centered approach focusing on individualized care, emphasizes lifestyle modifications, and utilizes a multidisciplinary team-based approach. By embracing this transition, healthcare providers can better address the interconnected and complex nature of metabolic disorders and provide more effective and personalized care to their patients."

"Patients with type 2 diabetes requiring additional benefits for the management of multiple comorbidities along with glycaemic control may find SGLT inhibitors a promising therapy, particularly considering obesity, diabetes burden, and associated CV and other comorbidities in the Indian population," the researchers concluded.

Reference:

Kumar, K M Prasanna; Unnikrishnan, A G1; Jariwala, Pankaj2; Mehta, Ashwani3; Chaturvedi, Richa4; Panchal, Sagar5; Lakhani, Preet5; Acharya, Rachana5; Dixit, Jitendra6. SGLT2 Inhibitors: Paradigm Shift from Diabetes Care to Metabolic Care—An Indian Perspective. Indian Journal of Endocrinology and Metabolism 28(1):p 11-18, Jan–Feb 2024. | DOI: 10.4103/ijem.ijem_377_23