De nier: target voor bloedglucoseverlagende therapie

28-11-2011
Edwin Duijzer, Manon Zwakenberg en Hiddo J. Lambers Heerspink

The kidney: target for blood glucose-lowering therapy

Conflict of interest: H.J. Lambers Heerspink is a member of the Abbott Steering Committee. His institute received consulting fees from Johnson & Johnson, grants from Abbott Research Support and payment for lectures from Abbott. Financial support for this article: none declared.

  • Diabetes mellitus is characterised by a dysregulated glucose metabolism and is accompanied by an elevated risk of micro- and macrovascular complications.

  • Despite the current array of drugs, a substantial number of patients do not meet the recommended target values for blood glucose, blood pressure and other cardiovascular risk factors. This calls for more effective treatment strategies.

  • The sodium-dependent glucose cotransporter 2 (SGLT2) located in the proximal tubule of the kidney reabsorbs virtually all filtered glucose and plays an important role in glucose regulation. Inhibition of SGLT2 results in increased urinary glucose excretion, and reduction of plasma glucose and HbA1c levels.

  • In addition, SGLT2 inhibition reduces blood pressure and body weight, and there seem to be positive changes in the triglyceride concentration.

  • Because of these beneficial effects, oral SGLT2 inhibitors could be important in the treatment of diabetes mellitus type 2.

  • Long-term studies are needed to confirm if they lower the cardiovascular risk and if they can be used safely.

  • The possible connection between increased urinary glucose excretion and urogenital infections also requires further investigation.