Gliflozins are a class of medications primarily used to manage type 2 diabetes. These drugs offer a distinct approach by influencing how the body handles glucose. Their actions extend beyond lowering blood sugar, providing additional health advantages.
How Gliflozins Work
Gliflozins target a specific protein in the kidneys called sodium-glucose cotransporter 2 (SGLT2). SGLT2 is responsible for reabsorbing most glucose filtered by the kidneys back into the bloodstream. Normally, kidneys efficiently reclaim nearly all filtered glucose when blood sugar levels are healthy.
Gliflozins block SGLT2 activity in the renal tubules. This prevents glucose reabsorption, causing more glucose to remain in the urine. The excess glucose is then excreted through urination, lowering blood sugar levels in individuals with type 2 diabetes. This mechanism is independent of insulin, offering a different pathway for glucose reduction compared to many other diabetes medications.
Gliflozins originated from phlorizin, a natural compound found in apple tree bark. Phlorizin was found to induce glucose excretion in urine. However, phlorizin itself was unsuitable as a medication due to its poor absorption and non-selective SGLT1/SGLT2 inhibition, which could lead to gastrointestinal side effects. Scientists later modified phlorizin’s structure to create more stable, selective gliflozins.
Expanding Health Benefits
Beyond their primary role in blood sugar management, gliflozins have demonstrated significant positive effects on cardiovascular and renal health. These benefits extend to individuals with and without type 2 diabetes, marking a substantial advance in treatment strategies for conditions like congestive heart failure and chronic kidney disease.
For congestive heart failure, gliflozins have been shown to reduce the risk of cardiovascular death and hospitalizations. While the exact mechanisms are still being explored, it is thought that these drugs help by reducing fluid overload, lowering blood pressure, and improving the heart’s energy efficiency. They may also reduce inflammation and oxidative stress, which contribute to heart damage.
In chronic kidney disease, gliflozins have been found to slow the progression of kidney damage and reduce the risk of kidney failure. They achieve this by reducing pressure within the kidney’s filtering units (glomeruli), which can protect delicate kidney structures from injury. They also lessen the amount of protein in the urine, a marker of kidney damage. These renal protective effects are observed across various stages of kidney disease.
Important Considerations and Safety
While gliflozins offer substantial benefits, potential side effects exist. Due to the increased excretion of glucose in the urine, individuals taking these medications may experience a higher incidence of genitourinary infections, such as yeast infections or urinary tract infections. Maintaining good hygiene can help reduce this risk.
Another consideration is the potential for dehydration, as the increased glucose excretion in urine can also lead to increased fluid loss. Patients are advised to maintain adequate fluid intake. A rare but serious side effect known as euglycemic diabetic ketoacidosis (DKA) can occur, where DKA develops despite blood sugar levels not being extremely high. This condition requires immediate medical attention.
Gliflozins are typically prescribed by a healthcare professional who will assess a patient’s health profile. It is important to discuss any existing medical conditions, especially kidney disease, before starting treatment. Adherence to the prescribed dosage and regular monitoring by a physician are recommended to ensure the safe and effective use of these medications.