SGLT-1 Inhibitors: The Future Class of Diabetes Medication

NOVEMBER 08, 2017
Kevin Kunzmann

We have a very interesting class of agents for diabetes, and that's the GLCP-1 receptor agonist class. And we have some recent data for liraglutide — very, very interesting study, the LEADER study, very good data showing a reduction of cardiovascular events that is statistically and, I think, clinically significant.

We have a newer drug called semaglutide, which actually is not yet approved, although it appears to be likely to be approved very soon. It is a once-a-week, instead of a once-a-day GLCP-1 receptor agonist. It also has very good data in the SUSTAIN-6 cardiovascular outcome trial.

So we have these 2 agents with some very promising, recent data showing clear benefit for cardiovascular outcomes. Everybody is aware of the fact that this is not a given, when we have a drug that treats glycemia, the question is does it also reduce cardiovascular disease? And the quick answer is that a majority of recent trials have failed to show cardiovascular benefit. So, the fact we have data from these 2 trials with these 2 agents for cardiovascular disease reduction is very helpful.

We also have some data from a similar drug — it's in the same category, and it's the once-a-week exenatide. It's comparable to semaglutide in that it's given once a week. It also showed benefit, although the benefit is a little bit more controversial, because it's a test of superiority, which is really our question here: Was this this short of reaching statistical significance? The statisticians are going to say, "There's no such thing as benefit with this agent." I think the clinicians among us will say, "This is probably a class effect, at least to the effect of these 3 agents."

We have yet another agent that's being used clinically,  that's dulaglutide. That one, we're still waiting for the cardiovascular outcomes data. So, it's a little hard to know whether it will have a benefit or not, given the fact our results so far are mixed.

We have some very exciting movement here, this class of drugs which has a lot of appeal because of weight loss, and because of very nice glucose control, and some other benefits. We now see cardiovascular intervention, and this has created a lot of excitement in the field, because as we treat a patient with diabetes, we have 12 different classes of drugs that can lower glucose levels, and to find good evidence with 2 or 3 different agents in that class that actually show cardiovascular event reduction, it's very exciting, and I think very motivating for us to prescribe these drugs, to use them along with other agents that also show benefit in cardiovascular disease or may not show, as the case may be.

It's a very exciting time to be treating diabetes as we're now better empowered to address the question of how do we not only reduce glucose and keep that under control, but how do we also reduce cardiovascular disease, which is the number one cause of both death and disability in patients with type 2 diabetes.

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