SGLT2 inhibitors aren’t your only option if metformin and diet and lifestyle changes aren’t lowering your blood sugar sufficiently. There are also medicines called GLP-1 receptor agonists that your doctor may add to your SGLT2 inhibitor and metformin regimen. Ozempic (semaglutide) and Trulicity (dulaglutide) are examples of GLP-1 receptor agonists, and you will inject these medications rather than taking them orally in pill form. Only your doctor can determine if you might benefit from any of these meds, so be sure to discuss all your options thoroughly. That might sound great, but it’s important to know these drugs aren’t used as a first-line treatment for controlling your blood sugar. According to the Mayo Clinic, initial diabetes therapy puts the ball in your court and includes:
Developing a diabetes-friendly dietMaking lifestyle changes such as quitting smokingStarting a regular exercise routineLosing weight
Next, your doctor may prescribe Glucophage (metformin), which is the gold-standard oral medication for treating type 2 diabetes, according to an August 2018 article in the journal Diabetes Care. Yet as researchers learn more about diabetes and diabetes complications, healthcare providers have gone from treating diabetes with a one-size-fits-all approach to customizing their recommendations according to individual needs, notes an article published in April 2012 in the journal Clinical Diabetes. Today, your doctor may broaden your type 2 diabetes treatment by adding medications such as Jardiance and Farxiga. When used with diet and exercise, these pills may help lower your blood sugar, improve the health of your heart and kidneys, and possibly help you lose weight and trim your waistline. Treatment with SGLT2 inhibitors focuses on preventing the risk of serious diabetes complications, including congestive heart failure and advanced kidney disease. “SGLT2 inhibitors initially came out as diabetes medicines,” Dr. Tan says. “But when researchers did cardio trials to show these drugs were safe, the surprising results showed they lowered cardiovascular disease, and for many patients with type 2 diabetes, the main killer is cardiovascular disease.” In fact, people with type 2 diabetes are twice as likely to die of heart disease as those without diabetes, notes the Centers for Disease Control and Prevention. Essentially, these drugs release glucose through the urine, Tan says. “Through urination, the body rids itself of extra sugar, lowers the patient’s blood sugar, helps with blood pressure, and reduces heart failure symptoms,” she says. SGLT2 inhibitors and medication combination options include:
Invokana (canagliflozin)Farxiga (dapagliflozin)Xigduo XR (dapagliflozin/metformin)Jardiance (empagliflozin)Glyxambi (empagliflozin/linagliptin)Synjardy (empagliflozin/metformin)Steglatro (ertugliflozin)
Screen-shot and print this list, or jot down the names on paper, and take it to your next doctor’s appointment so you’re prepared to discuss your options. A lower risk of death from heart disease or any cause In a randomized controlled trial of 7,020 people, participants who took empagliflozin had a 38 percent lower risk of heart disease-related deaths, a 35 percent lower risk of being hospitalized for heart failure, and a 32 percent lower risk of dying from any cause. Researchers published their findings in November 2015 in the New England Journal of Medicine. Weight loss and lower blood pressure A meta-analysis of 14 articles, which detailed 13 randomized controlled trials, suggests that SGLT2 inhibitors didn’t only help people with type 2 diabetes lower their A1C and improve their fasting glucose; the meds also helped lower their blood pressure and revved their weight loss. Study authors published their findings in the November–December 2015 issue of the Journal of Diabetes and Its Complications. Delayed kidney disease A review of 10 studies, published in January 2019 in Postgraduate Medicine, found that in people without kidney disease, taking an SGLT2 inhibitor was associated with lower levels of protein in the urine — a symptom of kidney disease — and a lower risk of developing this symptom. In people who had already developed kidney disease, the meds only offered short-term renal benefits, the authors note. On the basis of your personal health, your diabetes care team will be able to tell you which of these health effects you stand to benefit from most. Shira B. Eytan, MD, an assistant professor at Hofstra Northwell School of Medicine and Mount Sinai who practices at Park Avenue Endocrinology and Nutrition in New York City, says researchers aren’t sure how SGLT2 inhibitors produce these benefits. But, she says, “it appears to be separate from the effect of simply lowering blood glucose.” You can help avoid side effects — common and serious — by alerting your doctor to any underlying health conditions when you discuss whether an SGLT2 inhibitor is a good option for you. According to a 2018 article in Current Drug Safety, common side effects may include:
More urination and thus dehydrationUrinary tract infectionsVaginal yeast infections
Other, more serious adverse effects of SGLT2 inhibitors include:
Acute kidney injuryAmputations (primarily of the feet and legs)Bladder cancerBone fracturesDiabetic ketoacidosisGenitourinary tract infection
Call your doctor immediately if you have a serious side effect. Furthermore, because the FDA doesn’t regulate herbs and supplements the same way it does medications, you’ll want to let your doctor know if you’re taking any of these, too. But as of yet, these newer diabetes drugs aren’t approved for reducing those health issues. “SGLT2 inhibitors have not been approved for patients without type 2 diabetes,” Dr. Eytan says. “There are some ongoing studies for this class in prediabetics and metabolic syndrome, but we don’t yet have this data or FDA approval for these situations. Most physicians therefore wouldn’t yet prescribe in these cases and insurance companies won’t cover this medicine for these situations.” If you have type 2 diabetes with metabolic syndrome, some studies suggest that SGLT2 inhibitors may offer benefits. Findings mentioned above show SGLT2 inhibitors may improve the components of metabolic syndrome, including abnormal lipids, belly fat, hypertension, and glucose intolerance. Talk with your doctor to see if you’ll benefit from SGLT2 inhibitors for your diabetes treatment plan. Ask your doctor what that means for you, but one thing is for sure: You’ll want to stay hydrated, says Lynn Grieger RDN, CDE, the owner of Real Living Nutrition Services and a medical reviewer for Everyday Health. “I encourage patients to drink water — maybe 8 to 12 ounces with every meal and every snack to stay well hydrated,” Grieger says. “Also, lifestyle choices make a huge impact — food choices, physical activity, movement, sleep, and stress management. Usually people with diabetes are urged to follow a low-carb or moderate-carb diet. The latest guidelines recommend individualized diets for each person. If you eat very low carb, you risk dehydration.” When in doubt, consult a registered dietitian (you can find one at Eatright.org) to adjust your diet plan if needed.
