Maintenance of optimal glucose levels is major concern in treating patients with type 2 diabetes (Simmons et al., 2012). The management of this condition needs to be tailor-made to suit the circumstances and individual needs of patients. All benefits accrued from regulated glucose levels should be assessed in the light of future potential complications. Treatment needs to be effective to prevent recurrent hypoglycaemia. It is imperative for health care practitioners to conduct evidence-based research for effective management of type 2 diabetes. The clinical utility of sodium-glucose co-transporter 2 inhibitors in treating type 2 diabetes will be evaluated in this paper.
The underlying principle concerns the role of kidneys in ultrafiltration and reabsorption. Sodium glucose co-transporters (membrane proteins that transport glucose across the proximal tubule’s brush border membrane and intestinal epithelium) play crucial role in the reabsorption of glucose from kidneys. They mediate the reabsorption of glucose in the proximal convoluted tubule. Daily about 180 grams of glucose is filtered by a healthy adult’s kidneys. A large portion of glucose is reabsorbed by sodium glucose co-transporters and only less than 1% of glucose is excreted in urine. The inhibition of sodium glucose co-transporter 2 is a viable intervention in lowering the already elevated levels of blood glucose in diabetes patients. This application stands to benefit diabetic individuals as it is an effective mechanism of lowering blood glucose levels (Kim & Babu, 2012).
Summary of article
Kim and Babu (2012) have conducted a review, “Clinical potential of sodium-glucose co-transporter 2 (SGLT 2) inhibitors in the management of type 2 diabetes” that was published in the journal Diabetes Metabolic Syndrome Obesity. The researchers aimed to evaluate the physiology of SGLT 2 and examine the role of SGLT 2 inhibitors that have exhibited clinical efficacy in type 2 diabetes patients. The researchers have established that SGLT 2 inhibitors serve to correct a pathophysiological defect of high blood glucose in type 2 diabetes patients following insulin resistance and insulin deficiency to a small extent. Their action is insulin-independent and they also reduce the levels of glycosylated hemoglobin by 1.5 %. Other benefits include: weight loss (caloric loss of glucose), lower hypoglycemia incidence, and they work as complementary agents alongside with anti-diabetic agents. SGLT 2 inhibitors can be administered at all diabetes stages and have shown remarkable tolerance amongst patients. They should be administered under close supervision, as some side effects have been cited. This includes repeated genital and urinary tract infections, low blood pressure (achieved via improved glycemic control) and high hematocrit (Kim & Babu, 2012).
Effective inhibitors for SGLT 1 and SGLT 2 have been identified. These include: dapagliflozin, ipragliflozin, remogliflozin and canagliflozin.
It is selective and orally active inhibitor of SGLT 2. It exhibits linear pharmacokinetics and ranges from 2.5- 500 mg/day. The drug is eliminated primarily via kidneys. In both pharmacodynamic and pharmacokinetic studies, the dose-proportional parameters have been predictable across populations worldwide in type 2 diabetes patients and healthy individuals. Dapagliflozin can be administered at any time regardless of food consumption. The drug’s half life is about 17 hours. Glucosuria is dependent on dosage and ranges from 18 to 62 g and this effect is sustained (Kim & Babu, 2012).
In a phase I study, the following was established. The drug is readily absorbed and its half life ranges from 15 to 16 hours. This is an indicator that a daily single dose is adequate. The glucose mean renal threshold decreases in a fashion that is dose dependent. Few patients report transient postural dizziness and transient postural hypotension. Generally, the drug is well-tolerated and there are no events of hypoglycaemia. A phase II double-blind, placebo-controlled study gave more elaborate results concerning the pharmacokinetics of canagliflozin. For the group receiving canagliflozin, there was a significant reduction of HbA1c. The group also had reduced plasma glucose (16-27 mg/dL lower). Body weight was also reduced by 2.3% to 3.4% for the group (Sha et al., 2011).
The drug is readily absorbed and has a half life of 12 hours. The latter suggests that single daily dose is adequate. In a double-blind placebo-controlled study, the group receiving ipragliflozin exhibited reduction in mean HbA1c by 0.61 % - 0.84 %. The fasting plasma glucose was significantly lower by 2.7–3.9 mmol/L (48.6–70.2 mg/dL). Body weight was reduced by 3.0-3.8 kg. as compared to a weight gain of 1.6 kg. observed in the placebo group (Veltkamp et al., 2011).
In a double-blind placebo-controlled study, the mean fasting plasma glucose was reduced by 2.1–2.3 mmol/L (37.8–41.4 mg/dL) in the group receiving remogliflozin. Body weight was reduced by 2.3–4.5 kg. in the remogliflozin group as compared to a weight gain of 1.6 kg. observed in the placebo group. The excretion of glucose in urine exhibited a nonlinear pattern and saturation was noted at higher doses.
Significance of findings in nursing practice
SGLT 1 and SGLT 2 inhibitors can be safely used to treat type 2 diabetes. The activity of these inhibitors is insulin-dependent and the drugs are well-tolerated. The drugs have effectively caused weight loss. This is significant as diabetes patients are highly predisposed to obesity due to high level of blood glucose. Caution needs to be taken when administering the drugs to patients with renal problems and those presenting side effects, such as urinary tract infections, increased hematocrit, genital infections and low blood pressure (Kim & Babu, 2012).
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