Essay Example on Newest oral Antihyperglycemic medications to be Approved

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Sodium glucose co transporter 2 inhibitors SGLT2i are the newest oral antihyperglycemic medications to be approved in 2013 by the Food and Drug Administration FDA for the treatment of patients with type 2 diabetes mellitus T2DM SGLT2 inhibitors help in reduction in blood glucose without stimulating insulin release It also help weight loss and decrease blood pressure Its use is rising and is being one of the favorites among clinicians In 2015 FDA released warning about Diabetes Ketoacidosis with normal glucose EuDKA as potential side effect of SGLT2i In this review we tried to investigate the relationship between SGLT 2 inhibitor and EuDKA in patients with diabetes Numerous databases were searched to identify appropriate primary literature Search terms included SGLT2 sodium glucose cotransporter 2 inhibitor diabetic ketoacidosis ketoacidosis metabolic acidosis and Euglycemic diabetes ketoacidosis Primary literatures and case reports were searched on Pubmed Cochrane library and Google Cases of DKA taking SGLT 2 with blood sugar below 250mg dl at presentation were only included Total of 26 cases were included for this review 38 patient were T1DM and 61 were T2DM with average blood glucose of 170 3 43 3 mg dl 77 cases were taking Canagliflozin All cases had low pH and high Anion Gap during presentation Major precipitating factors for T2DM were reduction in insulin dose where surgery and infection triggered DKA in most of T2DM Most common symptoms were vomiting Nausea and abdomen pain Diagnosis difficulties were present due to non markedly elevated blood sugar with three cases of misdiagnosis and delayed treatment 




Almost all cases were treated at ICU as typical DKA and responded well to IV fluids and Insulin No death was reported among these cases We concluded that in absence of good laboratory resources EuDka can be very difficult to diagnose Clinician should be well aware of this condition of DKA with normal glucose level Precipitating factor and detailed medical and dietary history may help to identify patient with higher risk of developing DKA while using SGLT2 inhibitors Introduction There is a rising worldwide prevalence of diabetes which is one of the most challenging health problems in the 21st century Globally an estimated 422 million adults were living with diabetes in 2014 compared to 108 million in 1980 with prevalence rising from 4 7 to 8 5 in the adult population 1 American Diabetes Association ADA states that One in three American adults will have diabetes in the year 2050 if current trends continue and estimates a person diagnosed at age 50 dies six years earlier than a person without diabetes Latest survey showed that India has the highest number of people suffering from diabetes followed by China and then United States 2 The optimal treatments for diabetic patients are effective blood glucose control blood pressure and lipids control and to avert the serious complications associated with sustained tissue exposure to excessively high glucose concentrations Prevention and control of diabetes with diet weight control and physical activity has been difficult Different drugs including insulin are used to control the high blood sugar but many still fails to reach the goal despite dedicated efforts to achieve glycemic control
A new drug SGLT 2 inhibitor was approved by FDA in 2013 for treatment of diabetes and has been showing its efficacy ever since But there have been reports of some life-threatening side effects associated with this class of drug one of which is ketoacidosis with or without elevated glucose level In march 2015 FDA warned that SGLT2 inhibitors for diabetes may result in a the serious condition of too much acid in the blood and suggested considering labeling the drug with warning of DKA 3 Sodium-Glucose Co Transporter 2 inhibitor Sodium-glucose co-transporter 2 inhibitors SGLT2i are the newest oral antihyperglycemic medications to be approved by the Food and Drug Administration FDA for the treatment of patients with type 2 diabetes mellitus T2DM SGLT2 inhibitors provide insulin-independent glucose lowering by blocking glucose reabsorption in the proximal renal tubule by inhibiting SGLT2 4 SGLT2 inhibitors help in reduction in blood glucose without stimulating insulin release It also has other beneficial effects on blood pressure BP reduction and weight loss 5 EMPA REG OUTCOME study has demonstrated the positive cardiovascular outcomes of SGLT2 inhibitors 6 Approximately 180g of glucose per day is filtered by the kidneys 7


This glucose is reabsorbed by Sodium-glucose co-transporter proteins at proximal tubules of the kidney There are several types of SGLT proteins that are insulin-independent and inhibiting these proteins resulted in changes that improved carbohydrate metabolism which became an attractive concept for the treatment of diabetes8 SGLT1 proteins are high-affinity low capacity transporters of glucose which are found in the small intestines and the proximal tubule of the kidneys whereas SGLT2 proteins are found in the proximal convoluted tubule of the kidneys The SGLT1 proteins in the proximal convoluted tubule of the kidneys are responsible for less than 10 of filtered glucose reabsorption whereas SGLT2 proteins are responsible for roughly 90 of filtered glucose reabsorption making it a genuine target for diabetes treatment 5 Also SGLT1 has more gastrointestinal side effects like severe diarrhea due to involvement in small intestine 9




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