Differences

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--- endocrine:sglt2:start [2026/02/13 00:05] – created andrew2393cns
+++ endocrine:sglt2:start [2026/02/13 00:07] (current) – [SGLT2 vs Other Metabolic Agents] andrew2393cns
@@ Line 1: / Line 1: @@
 ====== SGLT2 Inhibitors (Gliflozins) ======
-SGLT2 inhibitors are glucose-lowering agents that block sodium-glucose cotransporter-2 in the proximal tubule.
+SGLT2 inhibitors are sodium-glucose cotransporter-2 inhibitors that act in the proximal tubule of the kidney.
-They were developed for diabetes but are now foundational therapies in:
+Originally developed for Type 2 Diabetes, they are now foundational therapies in:
 • [[cardio:heart_failure:start|Heart Failure]]
 • Chronic Kidney Disease
-• Type 2 Diabetes
+• Type 2 Diabetes Mellitus
-These drugs provide cardiovascular and renal protection independent of glucose lowering.
+Their cardiovascular and renal benefits extend beyond glucose lowering.
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@@ Line 16: / Line 16: @@
 Location:
 • Proximal convoluted tubule
-Action:
+Normal physiology:
+• SGLT2 reabsorbs ~90% of filtered glucose
-• Block SGLT2 transporter
+• Sodium and glucose are co-transported
-• Decrease glucose reabsorption
-• Increase urinary glucose excretion
-• Increase mild natriuresis
-Net Effects:
+Drug effect:
+• Blocks SGLT2
+• Increases urinary glucose excretion
+• Causes mild natriuresis
+• Reduces intraglomerular pressure
-• Lower blood glucose
+Net physiologic effects:
-• Mild diuresis
+• ↓ Blood glucose
-• Reduce intraglomerular pressure
+• Mild osmotic diuresis
-• Improve cardiac energetics
+• ↓ Preload
-• Reduce heart failure hospitalization
+• ↓ Blood pressure
+• ↓ Cardiorenal stress
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@@ Line 38: / Line 39: @@
 ===== Available Agents =====
-• [[endocrine:sglt2:dapagliflozin|Dapagliflozin]]
+  * • [[endocrine:sglt2:dapagliflozin|Dapagliflozin]]
-• [[endocrine:sglt2:empagliflozin|Empagliflozin]]
+  * • [[endocrine:sglt2:empagliflozin|Empagliflozin]]
-• [[endocrine:sglt2:sotagliflozin|Sotagliflozin]]
+  * • [[endocrine:sglt2:sotagliflozin|Sotagliflozin]]
-All share similar mechanisms.
+All share similar cardiorenal benefits.
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-# Indications
+===== Indications =====
-===== Type 2 Diabetes =====
+==== Type 2 Diabetes Mellitus ====
 • Improve glycemic control
+• Promote modest weight loss
 • Reduce cardiovascular events
-• Promote weight loss
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-===== Heart Failure ★ =====
+==== Heart Failure ★ ====
 Indicated for:
@@ Line 64: / Line 65: @@
 Benefits:
+• ↓ Heart failure hospitalization
-• Reduce hospitalization
+• ↓ Cardiovascular mortality
-• Reduce cardiovascular mortality
 • Effective regardless of diabetes status
+Part of the Four Pillars in HFrEF.
 → [[cardio:heart_failure:start|Heart Failure Module]]
-These are one of the Four Pillars in HFrEF.
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-===== Chronic Kidney Disease =====
+==== Chronic Kidney Disease ====
-• Reduce progression of CKD
+• Slows progression of CKD
-• Lower albuminuria
+• Reduces albuminuria
-• Slow decline in GFR
+• Preserves GFR
 Renal benefit independent of diabetes.
@@ Line 85: / Line 85: @@
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-# Adverse Effects
+===== Adverse Effects =====
 Common:
@@ Line 94: / Line 94: @@
 • Hypotension
-Serious:
+Serious (rare):
-• Euglycemic DKA (rare)
+• Euglycemic DKA
-• Fournier gangrene (rare)
+• Fournier gangrene
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-# Contraindications
+===== Contraindications / Cautions =====
 • Type 1 diabetes (DKA risk)
 • Severe volume depletion
-• Advanced renal failure (varies by drug)
+• Advanced renal impairment (varies by agent)
+Hold during acute illness or prolonged fasting.
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-# SGLT2 vs Other Diabetes Agents
+===== SGLT2 vs Other Metabolic Agents =====
-Unlike:
+Compared to:
 • [[endocrine:glp1:start|GLP-1 Receptor Agonists]]
 SGLT2 inhibitors:
+  * • Strong heart failure benefit
+  * • Strong renal protection
+  * • Mild diuretic effect
-• Provide strong heart failure benefit
+GLP-1 receptor agonists:
-• Provide renal protection
+  * • Greater weight loss
-• Cause mild diuresis
+  * • Stronger atherosclerotic benefit
-GLP-1 agents:
-• Stronger weight loss
-• Greater atherosclerotic benefit
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-# Clinical Pearls
+===== Clinical Pearls =====
-✔ Work in proximal tubule
+✔ Act in the proximal tubule
 ✔ Mild diuretic effect
 ✔ Reduce HF hospitalization
-✔ Reduce CKD progression
+✔ Slow CKD progression
 ✔ Benefit independent of diabetes status
-✔ Part of HFrEF Four Pillars
+✔ One of the Four Pillars of HFrEF
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