Vladimír Uličiansky
The kidneys play a central role in glucose homeostasis. Sodium-glucose co-transporter 2 (SGLT2) reabsorbs most glucose filtered by the glomerulus. This mechanism becomes maladaptive in diabetes. Results of randomised clinical trials have shown the blood glucose-lowering efficacy of SGLT2 inhibitors in type 2 diabetes in monotherapy, or used in addition to other glucose-lowering therapies including insulin. Dapagliflozin is a stable and highly selective inhibitor of SGLT2. Binding of dapagliflozin to SGLT2 inhibits renal glucose reabsorption, promotes urinary glucose excretion, and thereby lowers hyperglycaemia. Increased renal glucose elimination assists weight loss and slightly reduces blood pressure. Effective SGLT2 inhibition needs adequate glomerular filtration and might increase risk of urinary tract and genital infection. The insulin-independent mechanism of action of SGLT inhibitors is associated with low risk of hypoglycaemia. SGLT2 inhibitors represent a novel therapeutic approach for the treatment of diabetes.