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NEW DIRECTIONS IN PHARMACOLOGICAL TREATMENT WITH SGLT-2 INHIBITOR MOLECULES IN THE LIGHT OF CURRENT GUIDELINES FOR DIABETES MELLITUS, HEART FAILURE AND KIDNEY DISEASE

MARIANA CORNELIA TILINCA 1,2, CSILLA ANTAL 2, ANDREEA SĂLCUDEAN 3*, BIANCA LARISA ABĂLAȘEI 4, ROXANA MARIA FĂRCAȘ 2, ALEXANDRA GROȘAN 5

1Department of Internal Medicine I, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540142, Romania
2Department of Diabetology, Emergency Clinical County Hospital of Târgu Mureș, 540042, Romania
3Department of Ethics and Social Sciences, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540142, Romania
4Department of Psychiatry II, Clinical County Hospital of Târgu Mureș, 540072, Romania
5Department of Pharmacology and Clinical Pharmacy, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540142, Romania

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Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, a newer class of oral anti-hyperglycaemic agents, have been shown to improve cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2DM), by reducing the risk of heart failure, cardiovascular death, and renal events. This review aimed to describe the mechanism of action and clinical benefits of SGLT-2 inhibitors, highlighting their cardiorenal protection, glucose lowering effects, and their efficacy in the management of T2DM with multiple risk factors. SGLT-2 inhibitors reduce the reabsorption of sodium and glucose from the proximal tubules, thereby increasing renal glucose and sodium excretion. In addition to their glucose-lowering property, the clinical benefits of SGLT-2 inhibitors involve weight loss and major cardio- and reno-protective effects such as decreased preload and afterload, reversed cardiac remodelling, improved endothelial function, reduced albuminuria, improved glomerular hemodynamic and preserved kidney function. Therefore, SGLT2 inhibitors are a crucial component of management guidelines for diabetes, heart failure and chronic kidney disease, even in those without T2DM.