Theocharis Koufakis1, Omar G Mustafa2, Ramzi A Ajjan3, Xavier Garcia-Moll4, Pantelis Zebekakis1, George Dimitriadis5, Kalliopi Kotsa1. 1. Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 2. Department of Diabetes, King's College Hospital, London, UK. 3. Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds Ringgold Standard Institution, Leeds, UK. 4. Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain. 5. Second Department of Internal Medicine, Research Institute and Diabetes Center, Athens University Medical School, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Abstract
WHAT IS KNOWN AND OBJECTIVE: In the outpatient setting, sodium-glucose co-transporter 2 inhibitors (SGLT2i) are recognized as effective agents to optimize glycaemia and also developing robust evidence for cardiovascular (CV) and renal protection in people with type 2 diabetes, particularly those at higher risk. However, data on the safety and efficacy of these drugs in hospitalized patients remain limited. The purpose of this review is to discuss the balance between risks and benefits of SGLT2i use in the inpatient setting. METHODS: PubMed, Embase and Google Scholar databases were searched to identify relevant published work. Available evidence on the mechanisms of action and the safety profile of SGLT2i in the context of their use in hospitalized individuals are summarized and discussed in this narrative review. RESULTS AND DISCUSSION: The rationale behind the use of these agents in the inpatient setting is based on the low risk of hypoglycaemia, the practical dosing scheme and the potential to decrease subsequent heart failure admission rates. In addition, data from animal studies indicate the ability of SGLT2i to ameliorate oxidative stress, suppress sympathetic activity, enhance autophagy and promote cardiac remodelling, when administered in the acute phase of CV episodes. On the other hand, these drugs have been linked to specific adverse events related to their mechanism of action, including an increased risk of euglycaemic diabetic ketoacidosis and volume depletion, which raises concerns over their usefulness in inpatients, particularly individuals with multimorbidities. WHAT IS NEW AND CONCLUSION: Potential benefits deriving from the use of SGLT2i in the inpatient setting cannot mitigate possible risks, at least until robust evidence on their efficacy in hospitalized individuals become available. The concept of administering these agents in the acute phase of CV episodes, in people with or without diabetes, requires further evaluation in appropriately designed clinical studies.
WHAT IS KNOWN AND OBJECTIVE: In the outpatient setting, sodium-glucose co-transporter 2 inhibitors (SGLT2i) are recognized as effective agents to optimize glycaemia and also developing robust evidence for cardiovascular (CV) and renal protection in people with type 2 diabetes, particularly those at higher risk. However, data on the safety and efficacy of these drugs in hospitalized patients remain limited. The purpose of this review is to discuss the balance between risks and benefits of SGLT2i use in the inpatient setting. METHODS: PubMed, Embase and Google Scholar databases were searched to identify relevant published work. Available evidence on the mechanisms of action and the safety profile of SGLT2i in the context of their use in hospitalized individuals are summarized and discussed in this narrative review. RESULTS AND DISCUSSION: The rationale behind the use of these agents in the inpatient setting is based on the low risk of hypoglycaemia, the practical dosing scheme and the potential to decrease subsequent heart failure admission rates. In addition, data from animal studies indicate the ability of SGLT2i to ameliorate oxidative stress, suppress sympathetic activity, enhance autophagy and promote cardiac remodelling, when administered in the acute phase of CV episodes. On the other hand, these drugs have been linked to specific adverse events related to their mechanism of action, including an increased risk of euglycaemic diabetic ketoacidosis and volume depletion, which raises concerns over their usefulness in inpatients, particularly individuals with multimorbidities. WHAT IS NEW AND CONCLUSION: Potential benefits deriving from the use of SGLT2i in the inpatient setting cannot mitigate possible risks, at least until robust evidence on their efficacy in hospitalized individuals become available. The concept of administering these agents in the acute phase of CV episodes, in people with or without diabetes, requires further evaluation in appropriately designed clinical studies.
Authors: Jingtong Huang; Andrea M Yeung; Kevin T Nguyen; Nicole Y Xu; Jean-Charles Preiser; Robert J Rushakoff; Jane Jeffrie Seley; Guillermo E Umpierrez; Amisha Wallia; Andjela T Drincic; Roma Gianchandani; M Cecilia Lansang; Umesh Masharani; Nestoras Mathioudakis; Francisco J Pasquel; Signe Schmidt; Viral N Shah; Elias K Spanakis; Andreas Stuhr; Gerlies M Treiber; David C Klonoff Journal: J Diabetes Sci Technol Date: 2022-07-29
Authors: Jenny Hui Ling Chieng; Tze Kai Sia; Yao Hao Teo; Joseph Zi An Wong; Tricia Jing Ying Ng; Yao Neng Teo; Nicholas L X Syn; Robin Cherian; Yoke-Ching Lim; Ping Chai; Weiqin Lin; Raymond C C Wong; Ching-Hui Sia Journal: Med Princ Pract Date: 2022-04-04 Impact factor: 2.132