Sodium–Glucose Co-Transporters Inhibitors for Type 2 Diabetes Mellitus: The ‘New Kids on the Block’ in the Era of Evidence-based Medicine

Type 2 diabetes mellitus (T2DM) is a global crisis. Asia has a young, economically productive population at high risk of the disease. Poor blood glucose control and its associated risk factors resulting in disabling complications will have a catastrophic impact on patients with T2DM, their families, society, the healthcare system and the economy. Inhibiting sodium–glucose co-transporters (SGLT1/SGLT2) in the gastrointestinal tract and kidneys is the latest novel therapeutic pathway in managing the disease. In addition to controlling blood glucose, SGLT inhibitors may also reduce weight and lower blood pressure. However, these drugs are so new that long-term safety data is unavailable. Currently, six SGLT2 inhibitors are available for clinical use; they are continuously monitored for long-term adverse effects by drug regulatory authorities. Although there is some data suggesting benefits favouring Asians, most of the existing evidence from randomised controlled trials (RCTs) level are not applicable to patients in Asia with T2DM. High-quality RCTs reflecting realworld practice in this region are required for evidence-based medicine (EBM) to improve clinical care and justify the significant investments their development have required. Along with the production of high-quality EBM, emerging economies in Asia have the potential to play important roles in developing and facilitating evidence from RCTs for successful clinical practice utilisation. ‘First, do not harm’ is the fundamental tenet of clinical practice. Educating consumers of EBM about the importance of critical thinking, primary data accuracy, consistency and high-quality EBM for safe clinical practice are essential.

Keywords: Anti-hyperglycemic agents, Anti-diabetic agents, Cardiovascular outcomes, Clinical trials, Complications, Dapagliflozin, Diabetes mellitus, Efficacy, Empagliflozin, Euglycemic diabetic ketoacidosis, Evidence-based medicine, Glucose homeostasis, Glucosuria, Glycaemic control, Glycosylated haemoglobin, Hyperglycaemia, Ipragliflozin, Luseogliflozin, Perineal hygiene, Renal function, Risk factors, Sodium–glucose co-transporters inhibitors, SGLT inhibitors, Therapeutics, Tofogliflozin, Type 2, Weight reduction.