Kidneys: The new targets for type 2 diabetes mellitus treatment?

Diabetes undoubtedly is one of the most dreaded diseases. This lifelong illness can come with a host of debilitating complications, including blindness, kidney failure, heart attack and stroke. However, the good news is that these are largely preventable through good control of blood glucose, blood pressure and cholesterol levels.

The battle to achieve good glycemic control is a major therapeutic challenge both for healthcare professionals and their patients. The treatment starts with healthy-living habits that include a balanced diet, 30-minute daily exercise and 5- to 10-percent weight loss for overweight patients.

For decades, medication to control blood glucose levels has centered on improving insulin supply together with regimen that improves insulin sensitivity by the body. Side effects like weight gain, hypoglycemia (low sugars), gastrointestinal symptoms and edema have limited the optimal use of these older drugs. Over this past decade, newer drugs that help regulate food intake and promote better communication between the gut and the pancreas have led to improved glycemic control. The latest drugs to join the market are a group of oral tablets that make patients release excess sugars into the urine.

Yes, you read that right! Where the kidneys just used to be candidates for complications, they are now targets for treatment. For years, experts knew that high blood glucose is partly due to difficulty in expelling excess glucose into the urine. They have discovered the major route by which glucose is reabsorbed by the kidneys, called sodium-glucose transporter-2 (SGLT-2). Blocking this pathway increases glucose excretion; hence the SGLT-2 inhibitors were invented.

The SGLT-2 inhibitors or the “gliflozins” excrete about 70 grams a day of glucose into the urine. Seventy grams of glucose translate to a loss of almost 300 calories a day leading to an average of 2- to 3.5-kilogram weight reduction in most clinical investigations. The weight loss includes some reduction in body fat. Hypoglycemia is rare and mild with the gliflozins. They also have the benefit of modest blood pressure reduction of 3 to 5 mm Hg. The excess sugar in the urine however has been associated with a slight increase in genital yeast infection and urinary tract infection, both of which are easily treatable with a low chance of recurrence.

They can be used alone or in combination with insulin or other oral antidiabetic medications. Dapagliflozin, the first SGLT-2 inhibitor in the Philippines, has been a welcome addition to the list of pharmacologic choices available for patients with type 2 diabetes but not approved for use in type 1. It is currently available only through prescription by a physician after an evaluation. These are exciting times as we expect and watch out for more medications that will soon be available.

Dr. Sjoberg Kho is the immediate past president of the Philippine Society of Endocrinology, Diabetes and Metabolism. The A to Z of Health Information Advocacy is a joint initiative of a group of medical specialists and supported by AstraZeneca Philippines aimed at raising public awareness on various diseases and providing health information and updates to the healthcare community.