Cardiorenal Effects of SGLT2 Inhibitors in Type 2 Diabetes
Summary
Type 2 diabetes mellitus carries a high risk of both cardiovascular and renal complications, with heart failure, atherosclerotic events and chronic kidney disease being leading causes of morbidity and mortality. Sodium–glucose co-transporter 2 (SGLT2) inhibitors were developed to improve glycaemic control by promoting glycosuria, but large outcome trials have unexpectedly revealed marked reductions in heart failure hospitalisation, cardiovascular death and progression of kidney disease. Mechanistically, SGLT2 inhibition restores tubuloglomerular feedback, lowers intraglomerular pressure and reduces albuminuria, while concomitant natriuresis and blood pressure lowering contribute to afterload reduction. These effects are complemented by weight loss, improved myocardial energetics and attenuation of inflammation and fibrosis. The benefits are observed across a wide range of baseline kidney function and are largely independent of baseline glucose levels, establishing SGLT2 inhibitors as first-line therapies in patients with type 2 diabetes at increased cardiovascular or renal risk globally.
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Cardiorenal Effects of SGLT2 Inhibitors in Type 2 Diabetes publication trend
The graph below shows the total number of articles in cardiorenal effects of sglt2 inhibitors in type 2 diabetes across all publications each year (not limited to Nature Index journals).
Technical terms
Sodium–glucose co-transporter 2 (SGLT2) inhibitor: A drug that blocks glucose reabsorption in the renal proximal tubule, promoting urinary glucose excretion. Estimated glomerular filtration rate (eGFR): A calculated index of kidney filtration capacity, based on serum creatinine and other patient factors. Albuminuria: The presence of albumin in urine, indicating glomerular injury. Urinary albumin-to-creatinine ratio (UACR): The ratio of urinary albumin to creatinine, used to quantify albuminuria and stratify renal risk. Tubuloglomerular feedback: A physiological mechanism by which changes in sodium delivery to the macula densa regulate glomerular filtration pressure.
References
- Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. The Lancet Diabetes & Endocrinology (2023).
- Long-term benefits of dapagliflozin on renal outcomes of type 2 diabetes under routine care: a comparative effectiveness study on propensity score matched cohorts at low renal risk. The Lancet Regional Health - Europe (2024).
- Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials. The Lancet (2022).
- SGLT2 Inhibitors: A Review of Their Antidiabetic and Cardioprotective Effects. International Journal of Environmental Research and Public Health (2019).
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