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An evidence-based practice-oriented review focusing on canagliflozin in the management of type 2 diabetes

Authors Messana JA, Schwartz SS, Townsend RR

Received 3 September 2016

Accepted for publication 12 November 2016

Published 17 February 2017 Volume 2017:13 Pages 43—54


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Daniel Duprez

Joseph A Messana,1 Stanley S Schwartz,2,3 Raymond R Townsend1

1Nephrology Division, Perelman School of Medicine, University of Pennsylvania, 2Main Line Health, 3Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA

Abstract: Caring for patients with type 2 diabetes mellitus (T2DM) has entered an era with many recent additions to the regimens used to clinically control their hyperglycemia. The most recent class of agents approved by the Food and Drug Administration (FDA) for T2DM is the sodium–glucose-linked transporter type 2 (SGLT2) inhibitors, which work principally in the proximal tubule of the kidney to block filtered glucose reabsorption. In the few years attending this new class arrival in the market, there has been a great deal of interest generated by the novel mechanism of action of SGLT2 inhibitors and by recent large outcome trials suggesting benefit on important clinical outcomes such as death, cardiovascular disease and kidney disease progression. In this review, we focus on canagliflozin, the first-in-class marketed SGLT2 inhibitor in the USA. In some cases, we included data from other SGLT2 inhibitors, such as outcomes in clinical trials, important insights on clinical features and benefits, and adverse effects. These agents represent a fundamentally different way of controlling blood glucose and for the first time in T2DM care to offer the opportunity to reduce glucose, blood pressure, and weight with effects sustained for at least 2 years. Important side effects include genital mycotic infections and the potential for orthostatic hypotension and rare instances of normoglycemic ketoacidosis. Active ongoing clinical trials promise to deepen our experience with the potential benefits, as well as the clinical risks attending the use of this new group of antidiabetic agents.

Keywords: SGLT2, canagliflozin, review, outcomes, type 2 diabetes mellitus

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