Generic placeholder image

Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Clinical Trial

Value of Sodium-Glucose Co-Transporter 2 Inhibitor Versus Traditional Medication in Microalbuminuric Diabetic Patients

Author(s): Nahla Hussein*, Fatma Abdelrahman, Abdelrahman Khedr, Hayam Aref, Mohamed Reda Halawa and Magdy ELSharkawy

Volume 17, Issue 6, 2021

Published on: 10 November, 2020

Article ID: e101120187809 Pages: 6

DOI: 10.2174/1573399816999201110194413

Price: $65

Abstract

Background: Sodium glucose co-transporter 2 inhibitor (SGLT2i) is a new arment in the prevention and treatment of diabetic kidney disease with a potential effect on reducing and preventing Chronic Kidney Disease (CKD) progression.

Objective: To evaluate the effect of SGLT2 inhibitor in comparison to traditional medication in diabetic patients with microalbuminuria.

Methods: A total of 60 diabetic patients with microalbuminuria were divided into group I, where 30 patients were treated by traditional medications (RAAS blockers) and group II where 30 patients were treated by Dapagliflozin added to the traditional medications. All patients were followed up for 6 months and their Urine Albumin/Creatinine Ratio (UACR) and eGFR changes were monitered.

Results: UACR significantly declined after 6 months of treatment in group II with a p-value <0.001. There were no significant eGFR changes between both groups. Systolic blood pressure decreases in both groups, but the decrease was highly significant in group II (pvalue<0.001). Diastolic blood pressure decreases significantly in both groups (p-value<0.001). Also, bodyweight reduced significantly in group II with a p-value<0.001.

Conclusion: Dapagliflozin, when added to traditional medications (RAAS Blockers), leads to a significant reduction in microalbuminuria with no significant eGFR changes.

Keywords: Diabetes mellitus, diabetic nephropathy, microalbuminuria, management, SGLT2 inhibitor, dapagliflozin.

[1]
Garofalo C, Borrelli S, Liberti ME, et al. SGLT2 inhibitors: Nephroprotective efficacy and side effects. Medicina (Kaunas) 2019; 55(6): 268.
[http://dx.doi.org/10.3390/medicina55060268] [PMID: 31212638]
[2]
De Nicola L, Gabbai FB, Liberti ME, Sagliocca A, Conte G, Minutolo R. Sodium/glucose cotransporter 2 inhibitors and prevention of diabetic nephropathy: targeting the renal tubule in diabetes. Am J Kidney Dis 2014; 64(1): 16-24.
[http://dx.doi.org/10.1053/j.ajkd.2014.02.010] [PMID: 24673844]
[3]
Komala MG, Panchapakesan U, Pollock C, Mather A. Sodium glucose cotransporter 2 and the diabetic kidney. Curr Opin Nephrol Hypertens 2013; 22(1): 113-9.
[http://dx.doi.org/10.1097/MNH.0b013e32835a17ae] [PMID: 23042029]
[4]
Wanner C, Inzucchi SE, Lachin JM, et al. EMPA-REG OUTCOME Investigators. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 2016; 375(4): 323-34.
[http://dx.doi.org/10.1056/NEJMoa1515920] [PMID: 27299675]
[5]
Neal B, Perkovic V, Mahaffey KW, et al. CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017; 377(7): 644-57.
[http://dx.doi.org/10.1056/NEJMoa1611925] [PMID: 28605608]
[6]
Jardine MJ, Mahaffey KW, Neal B, et al. CREDENCE study investigators. The canagliflozin and renal endpoints in diabetes with established nephropathy clinical evaluation (CREDENCE) study rationale, design, and baseline characteristics. Am J Nephrol 2017; 46(6): 462-72.
[http://dx.doi.org/10.1159/000484633] [PMID: 29253846]
[7]
McEwan P, Kartman B, Bennett H, Edmonds C, Gause-Nilsson I. Renal outcomes from the DECLARE-TIMI 58 trial: Quantifying the health-care implications. Diabetes 2019; 68(Suppl. 1): 15. [-OR.].
[http://dx.doi.org/10.2337/db19-15-OR]
[8]
Heerspink HJL, Stefansson BV, Chertow GM, et al. DAPA-CKD Investigators. Rationale and protocol of the dapagliflozin and prevention of adverse outcomes in chronic kidney disease (DAPA-CKD) randomized controlled trial. Nephrol Dial Transplant 2020; 35(2): 274-82.
[http://dx.doi.org/10.1093/ndt/gfz290] [PMID: 32030417]
[9]
Heerspink HJ, Johnsson E, Gause-Nilsson I, Cain VA, Sjöström CD. Dapagliflozin reduces albuminuria in patients with diabetes and hypertension receiving renin-angiotensin blockers. Diabetes Obes Metab 2016; 18(6): 590-7.
[http://dx.doi.org/10.1111/dom.12654] [PMID: 26936519]
[10]
Fadini GP, Solini A, Manca ML, et al. DARWIN-T2D Network. Effectiveness of dapagliflozin versus comparators on renal endpoints in the real world: A multicentre retrospective study. Diabetes Obes Metab 2019; 21(2): 252-60.
[http://dx.doi.org/10.1111/dom.13508] [PMID: 30136354]
[11]
Gunhan HG, Imre E, Erel P, Ustay O. Empagliflozin is more effective in reducing microalbuminuria and alt levels compared with dapagliflozin: real life experience. Acta Endocrinol (Bucur) 2020; 16(1): 59-67.
[http://dx.doi.org/10.4183/aeb.2020.59] [PMID: 32685040]
[12]
Fioretto P, Stefansson BV, Johnsson E, Cain VA, Sjöström CD. Dapagliflozin reduces albuminuria over 2 years in patients with type 2 diabetes mellitus and renal impairment. Diabetologia 2016; 59(9): 2036-9.
[http://dx.doi.org/10.1007/s00125-016-4017-1] [PMID: 27306615]
[13]
Fioretto P, Del Prato S, Buse JB, et al. DERIVE Study Investigators. Efficacy and safety of dapagliflozin in patients with type 2 diabetes and moderate renal impairment (chronic kidney disease stage 3A): The DERIVE Study. Diabetes Obes Metab 2018; 20(11): 2532-40.
[http://dx.doi.org/10.1111/dom.13413] [PMID: 29888547]
[14]
Mulder S, Hammarstedt A, Nagaraj SB, et al. A metabolomics-based molecular pathway analysis of how the sodium-glucose co-transporter-2 inhibitor dapagliflozin may slow kidney function decline in patients with diabetes. Diabetes Obes Metab 2020; 22(7): 1157-66.
[http://dx.doi.org/10.1111/dom.14018] [PMID: 32115853]
[15]
Sternlicht H, Bakris GL. Blood Pressure Lowering and Sodium-Glucose Co-transporter 2 Inhibitors (SGLT2is): More Than Osmotic Diuresis. Curr Hypertens Rep 2019; 21(2): 12.
[http://dx.doi.org/10.1007/s11906-019-0920-4] [PMID: 30747296]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy