A new class of drug for the management of type 2 diabetes: sodium glucose co-transporter inhibitors: 'Glucuretics'

Background: Type 2 diabetes is a common, chronic disease with a prevalence that is increasing at epidemic proportions. Management involves advice on lifestyle changes, oral anti-hyperglycaemic agents and/or insulin. The kidneys play a major role in the regulation of glucose, re-absorbing 99% of the plasma glucose filtered through the renal glomeruli tubules. The glucose transporter, SGLT2, which is found primarily in the S1 segment of the proximal renal tubule accounts for 90% of glucose re-absorption. Competitive inhibition of SGLT2 induces glucosuria in a dose dependent manner and appears to have beneficial effects on glucose regulation in individuals with type 2 diabetes. O-glucoside phlorozin is the model substance for SGLT2 inhibitors: various O-, C-, N- and S-glucosides with varying affinity and specificity have been synthesised. Aims: The aim of this review is to describe the background, the mechanism of action and the possible role for sodium glucose co-transporter inhibitors in the treatment of diabetes. Materials and methods: Databases, including MEDLINE, COCHRANE, EMBASE and EBM reviews were searched for literature relating to sodium glucose transport inhibitors and improvements in glycaemic control in patients with diabetes. Results: The data suggest that sodium glucose transport inhibitors significantly improve glycaemic control by increasing glucosuria. Some studies described significant reductions in weight and improvement in blood pressure. The most common side effect was infection involving the urinary and genital tracts. Conclusions: Sodium glucose co-transport inhibitors appear to be an effective line of treatment, well tolerated and could be a further drug class in the armamentarium available for the management of type 2 diabetes.