Deepak L. Bhatt, MD, MPH, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital Heart & Vascular Center and professor of medicine at Harvard Medical School, outlines the role that sodium glucose co-transporter (SGLT) inhibitors play in patients with diabetes and diminished glomerular filtration rates.
When prescribing sodium-glucose cotransporter (SGLT) inhibitors, it is important to consider the impact on glycemic control, said Deepak L. Bhatt, MD, MPH, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital Heart & Vascular Center and professor of medicine at Harvard Medical School.
Why is the range of effectiveness in the SGLT1/2 inhibitor in chronic kidney disease so important?
In patients with lowish GFR [glomerular filtration rate] and diabetes, SGLT2 inhibitors can be used. In fact, they do seem to provide clinical benefits. But in terms of glycemic control, which is why a lot of endocrinologists and primary care physicians are using diabetes drugs there, the current SGLT2 inhibitors that are available don't do a great job with respect to glycemic control. And we know glycemic control is important. Even though in recent years, we've focused on cardiovascular and cardiorenal outcomes, the glycemic control matters. It eventually will lead to microvascular complications, things like neuropathy and retinal damage if the glucose is just running out of control for too long. So there is a real benefit to glycemic control if it can be done safely. In patients with a diminished GFR, the SGLT2 inhibitors just aren't as effective as eliminating glucose through the urine because the GFR is low. But the SGLT1 inhibition from sotagliflozin could nicely fill in that gap, where it in the SCORED trial was seen, even in patients with low GFR, to provide a good degree of glycemic control similar to patients even with higher degrees of GFR with sotagliflozin. So that does seem to be a benefit that is specific to the SGLT1 mechanism of action.