New to the diabetes medication tool box – SGLT-2 inhibitors

We learn more every day about why type 2 diabetes occurs and how it can be treated. The newest class of medications,  SGLT-2 inhibitors (SGLT-2 is short for 'sodium glucose co-transporter 2') work to reduce the amount of glucose in the blood by increasing the amount of sugar lost in urine. It seems like a simple concept but, in all honestly, we are only now learning about the role that the kidney plays in diabetes management. SGLT-2 inhibitors are taken once daily, and when used alone, they do not cause low blood glucose levels. They can lower A1C by almost 1% and can be added to most diabetes therapies. What is really important to remember is that they do not work in the kidney itself. Rather, when sugar is already in the urine, these medications block the sugar from being reabsorbed in the distal tubule of the kidney; what this means is that some sugar stays in the urine and is lost when the bladder is emptied.

The first of the SGLT-2 inhibitors, called Invokana® (canagliflozin), was approved by Health Canada in May 2014. The exciting thing about this medication is that it can help you to lose the equivalent of 1 can of sugared pop every day. In fact, people who were enrolled in the clinical trials for Invokana had a consistent weight loss of 2 to 3 kg.

Who can use this medication?

Invokana® should only be used in people with type 2 diabetes with normal kidney function. It should not be used during pregnancy or breastfeeding. Invokana can be added to most diabetes medications, including metformin, glyburide, gliclazide and insulin. Using Invokana® with medications known to cause low blood glucose levels can increase the risk of low blood glucose, so other medications may need to be adjusted.

Side effects include yeast infections and urinary tract infections, so for people who already have difficulty with these ailments, this may not be your drug of choice.

Is Invokana® safe for your heart?

Since the news about Avandia® – a diabetes medication that was found to increase the risk of heart attack and heart failure in some people with diabetes – arose a few years ago, you may wonder if invokana may be safe in this regard. Two long-term studies are being conducted right now to determine the risks and/or benefits of using Invokana® in people with known heart disease or who are at risk of heart disease. Other long-term safety information will also come from these studies.

Is this exciting new class of medication right for you?

Diabetes treatment is individualized, so you should always ask your diabetes healthcare team about any new therapies that you are considering, and if they’re right for you. Also remember that this is a medication you need to ask your doctor about (for example, if you should continue to take if you become ill and are unable to eat or drink).

Here’s one final piece of good news: adding an SGLT-2 inhibitor to your diabetes medications does not increase the need to for you to check your blood glucose levels!