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Sodium-Glucose Cotransporter 2 Inhibitors in the Treatment of Type 2 Diabetes Mellitus

Purpose The purpose of this review article is to provide guidance to clinicians and diabetes educators regarding the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors as a therapeutic option for the treatment of patients with type 2 diabetes mellitus (T2DM). Methods The PubMed database was searched through February 2015 to identify clinical trials and meta-analyses evaluating the use of the SGLT2 inhibitors canagliflozin, dapagliflozin, and empagliflozin administered as monotherapy or in combination with other oral antidiabetes drugs or with insulin. Results SGLT2 inhibitors reduce hyperglycemia in an insulin-independent manner by inhibiting the reabsorption of glucose into the systemic circulation by the kidneys. In patients with T2DM, SGLT2 inhibitors provide consistent reductions in glycated hemoglobin, fasting plasma and postprandial glucose, body weight, and blood pressure when used as monotherapy or in combination with other oral antidiabetes agents or with insulin. SGLT2 inhibitors are associated with a low risk of hypoglycemia, except when used with agents known to be associated with a higher risk of hypoglycemia, such as sulfonylureas or insulin. Conclusions The unique renal-specific mechanism of action and favorable efficacy and safety profile of SGLT2 inhibitors support consideration of these antidiabetes agents as a treatment option for patients with T2DM.