Sunday, March 31, 2013

Glucoretics have arrived: A new class of anti diabetic drugs

The U.S. Food and Drug Administration approved the drug, Invokana, after data showed it was effective in lowering blood sugar in patients with Type 2 diabetes.
Known chemically as canagliflozin, Invokana is a member of a new class of diabetes treatments called sodium-glucose co-transporter-2 (SGLT2) inhibitors that lower blood sugar by blocking reabsorbtion of glucose and increasing its excretion in urine.
To me this sounds like a glucoretic. 

Some of the animal data had shown promise and then these class of drugs came into trials. Preclinical and clinical research has demonstrated that inhibition of SGLT2, the major pathway of renal glucose reabsorption, leads to increased urinary glucose excretion with concomitant reductions in fasting and postprandial plasma glucose levels, HbA1c levels and body mass. In animal studies, the drugs have been correlated with an increase in urinary volume and a reduction in body fat but not water content.They do mention that it is contra indicated in CKD and ESRD patients( well if you don't make urine, this will not be working for sure).

Why is this drug important for nephrologists? Well increased osmotic diuresis can perhaps lead to a pre renal insults, more urinary tract infections( due to the glucorectic effect), perhaps proximal tubular dysfunction or better yet- maybe it gives additional benefit of water loss leading to good blood pressure control. A recent study already looked at the drug's effect on CKD stage 3 patients. It was deemed safe in CKD Stage 3 based on that one study. 

Novel mechanism, lets wait and watch.


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