New perspective for the use of sodium-glucose co-transporter 2 inhibitors in diabetes mellitus

The main goal of both type 1 and type 2 diabetes treatment is reaching long-term and stable glycemic control with low frequency of hypoglycemic episodes. All antiabetic drugs have been tested for their cardiovascular safety. Beneficial micro- and macrovascular effects of some drugs have become an important factor for treatment choice. However, most oral hypoglycemic agents have been registered for the treatment of type 2 diabetes only. Sodium-glucose co-transporter 2 (SGLT2) inhibitors represent a novel group of antidiabetic drugs that acts by reducing renal reabsorption of glucose. In this review we discuss the mechanisms underlying non-glycemic effects of SGLT2 inhibitor dapagliflozin (reduction in body weight, systemic blood pressure, glomerular hypertension and albuminuria; nephroprotective properties). Clinical data on the dapagliflozin safety in terms of cardiovascular and cancer risks are analyzed. The problem of adverse effects (ketocidosis, dehydration, urogenital infections, fractures) and their prevention is discussed. In this article we also summarize limited foreign data on the use of dapagliflozin in type 1 diabetes that is currently considered to be a contraindication for the use of SGLT2 inhibitors in Russian Federation.