Flozin in Time

Putting aside all the crummy problems that come with diabetes, it’s a pleasure to watch good minds in action as they focus on how to control, and eventually defeat, the disease.

One of the best places to see what they’ve come up with is the annual scientific sessions of the American Diabetes Association, a five-day affair that brings together scientists from all over to give formal reports on their progress against diabetes.

For type 2s, an interesting pattern emerged a this year’s session in Philadelphia, June 8-12. A new class of oral drugs is coming to the fore as a treatment for improved glycemic control in type 2s: the SGLT2 inhibitors. They’re not yet on the market but you can expect them to appear soon.

These drugs are a different cat from the drugs most of us have been taking over the years. Basically, type 2 medications either work to up insulin production or sensitivity (sulfonylureas, for example) or tamp down the liver’s glucose production (metformin). Some drugs can do both: Byetta (exenatide) suppresses glucose production and stimulates insulin production.

But the SGLT2 inhibitors take an entirely different tack in addressing glycemic control.

SGLT, which stands for sodium-glucose transporter, refers to a process by which the kidneys process glucose and then return it to the bloodstream. By interfering with this process, so that glucose is excreted rather than retained, an SGLT inhibitor gives type 2 patients a third means of glycemic control.

I call these drugs “the Flozins,” since they all carry a tell-tale “flozin” at the end of their names. Data on three SGLT2s were presented at the ADA session: 

1. Canagliflozin, which presenters from Janssen research said could work as a monotherapy. They also said that in a head-to-head comparison with sitagliptin, patients taking canagliflozin experienced lower A1c’s, greater weight loss, reduce blood pressure, and raised HDL cholesterol. Canagliflozin is pending FDA approval as a type 2 therapy.
2. Taking a different approach, Bristol-Myers Squibb reported that its dapagliflozin, when used in conjunction with sitagliptin, demonstrated “significant reductions” in blood sugar levels over a 48-week period in conjunction with sitagliptin. The study involved adult type 2s whose sitagliptin-alone or sitagliptin/metformin therapy no longer produced the desired level of glycemic control. Bristol-Myers has applied to the FDA for approval to market dapagliflozin.
3. Empagliflozin from Eli Lilly and Boehringer Ingelheim Pharmaceuticals reduced A1c levels and body weight when used alone or as an add-on to metformin. The partners also reported that the empagliflozin/metformin combination outperformed sitagliptin.

The takeaway here is that some very creative minds have found another way to come at glycemic control. Type 2s still have to put up with major pains in our lives, but the array of aids that can  make our burden a little lighter grows more impressive each year.

(Disclaimer: I was recently involved in a Phase III trial for dapagliflozin. Given my results, I think that I was on placebo. None of the drug’s expected effects or side effects occurred with me: weight loss; somewhat increased urination; improved glycemic control. So I can’t vouch for the drug one way or another.)