#1

SGLT2 inhibitors as cardio-renal protective agents

Good news continues to come out on SGLT2 inhibitors as the research below highlights. This study was funded by the drug companies, so I’m more skeptical of its accuracy, but interesting to keep in mind:

another study:

and another:

Use of SGLT2 inhibitors was linked with a 6.1% lower risk of cardiovascular disease over 5 years (with up to an 11.1% lower risk in individuals with signs of kidney disease) and with a 5.3% lower risk of kidney failure (with up to a 7.6% lower risk in those with signs of kidney disease).

and as we’ve mentioned before, SGLT2 inhibitors can, for many people, help with weight loss during the first month of initiation. It doesn’t seem to continue after the initial month or so, but during that first month, with some diet adjustment and use of an SGLT2 inhibitor, people frequently lose 10 to 20lbs (and then plateau).

And on a cautionary note - some things to be aware of for those investigating canagliflozin and other SGLT2 inhibitors for anti-aging purposes:

Clinicians should be aware of the potential for the pharmacologic activity of SGLT2 inhibitors to persist long after the standard drug clearance period of five half‐lives, the typical duration used to guide pre‐operative medication recommendations.

And:

Rare Risk for ketoacidosis - A Case Report

Sodium-glucose cotransporter-2-inhibitors are relatively new substances for treating patients with diabetes mellitus. Not least because of their rare, but severe side effects - especially euglycemic ketoacidosis - anaesthesiologists and physicians in intensive care should know about the pharmacologic properties and risk profile of sodium-glucose cotransporter-inhibitors. The present case report demonstrates typical laboratory findings of severe euglycemic ketoacidosis in a patient with only unspecific symptoms under therapy with gliflozins in the perioperative period.

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#2

The present study examined if controlling hyperglycemia with empagliflozin, or given in combination with lisinopril, slows the progression of renal injury in hypertensive diabetic rats. Studies were performed using hypertensive streptozotocin-induced type 1 diabetic Dahl salt-sensitive (STZ-SS) rats and in deoxycorticosterone-salt hypertensive type 2 diabetic nephropathy (T2DN) rats. Administration of empagliflozin alone or in combination with lisinopril reduced blood glucose, proteinuria, glomerular injury, and renal fibrosis in STZ-SS rats without altering renal blood flow (RBF) or glomerular filtration rate (GFR). Blood pressure and renal hypertrophy were also reduced in rats treated with empagliflozin and lisinopril. Administration of empagliflozin alone or in combination with lisinopril lowered blood glucose, glomerulosclerosis, and renal fibrosis but had no effect on blood pressure, kidney weight, or proteinuria in hypertensive T2DN rats. RBF was not altered in any of the treatment groups, and GFR was elevated in empagliflozin-treated hypertensive T2DN rats. These results indicate that empagliflozin is highly effective in controlling blood glucose levels and slows the progression of renal injury in both hypertensive type 1 and type 2 diabetic rats, especially when given in combination with lisinopril to lower blood pressure.

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#3

Has anyone been successful in having their physician prescribe a (SGLT2) inhibitor and have it covered by their insurance?
I have ankle swelling at the end of the day, and a decreased eGFR, but no diabetes or solid proof of CHF or heart failure. I told this to my PCP who said I had to go through many hoops, take furosemide, get an echo, and even then try many things , until I exhausted all other options before they would even consider prescribing. There is no incentive for prevention.
Thanks

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#4

Nope no luck, which prompted me to roll the dice with Indiamart. So far so good. I have Empagliflozin 25mg. Tried 100 pills for $65 + shipping.

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#5

Thats my next step, thanks

#6

I am switching from acarbose to Invokana canagliflozin with hopefully fewer side effects.
FWIW: I have been buying various medications from India for over a year now with no problems and I have been very satisfied with the products I have received.

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#7

GPs play it too safe in my experience. I don’t feel like I got good preventative care until I found a good cardiologist.

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#8

Are the sides bad with Acarbose?

#9

100% you will have gas, but I have lost several pounds

#10

I spent a bit more for the brand name Jardiance (Empagliflozin) 25mg, 240.00 for 200 pills, including shipping through IndiaMART; I’m giving up on our US healthcare system!

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#11

For me, too much gassiness and cramping. I just never adjusted to it.
Some people seem okay with it. Maybe a different gut biome?

#12

Do you have much in the way of wheat-based products in your diet? I think this is the key problem associated with increase gas.

#13

None so far. I am gluten free, no dairy, sugar etc perhaps my diet helps.

#14

No, I tried avoiding wheat and it helped a little. Acarbose always gives me a bloated feeling.
Also, while it reduces blood sugar spikes, though because of my diet, I don’t usually have a large spike in blood sugar, it didn’t have any effect on my A1c level. So, I am going to see if canagliflozin lowers it. My doctor is not concerned about my blood sugar levels, but I am.

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#15

Did the SGLT2 inhibitor help with your ankle swelling? I have it as well, have had 4 different doctors look at it (who did blood tests, MRIs, immune system tests, etc.) and tell me they had no idea what the problem is. I also have some swelling in my left hand, neither my ankle nor my hand were injured. I have been tested for CHF and heart issues and have been cleared of those as well. All my blood tests come back fine. I came across your post and am hoping for some good news.

#16

Any thoughts on this research on Acarbose?

Association of Acarbose with Decreased Muscle Mass and Function in Patients with Type 2 Diabetes: A Retrospective, Cross-Sectional Study - PubMed.

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#17

Yes, my ankle swelling went down. The reason for hand swelling may be a completely different problem from my bilateral ankle swelling after a day of sitting at work.

#18

Yea, I have had them both looked at by many different docs and specialists and no one can tell me what the issue could be. It’s unilateral, but there is nothing with my heart, glucose and immune system that can explain it. I’ve learned to just cope with it, but I’d love a solution.

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#19

Interesting, thanks for posting

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#20

Dark teas include Qingzhuan brick tea, Kangzhuan brick tea, Liubao tea, and Ripen Pu-erh tea.

The authors agree that, as this is an observational study, their findings cannot prove that drinking tea improves blood sugar control. However, Dr. Wu did suggest why it might have this effect:

“These findings suggest that the actions of bioactive compounds in dark tea may directly or indirectly modulate glucose excretion in the kidneys, an effect, to some extent, mimicking that of sodium-glucose co-transporter-2 (SGLT2) inhibitorsTrusted Source, a new anti-diabetic drug class that is not only effective at preventing and treating type 2 diabetes but also has a substantial protective effects on the heart and kidneys.”

The research group is planning further investigations, as Dr. Wu told MNT:

“Our group is conducting a double-blind, randomized trial to further investigate the clinical effects of regular consumption of microbial fermented tea vs. black tea on glycemic control in people with type 2 diabetes, anticipating outcomes to be released in 2024.”

Puer tea is available in most Asian food stores.

Sample size is small. Effect is merely suggestive. But I like black tea. Puer tea has the same taste, despite the fermentation.

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