Inhibiteurs du SGLT2. Résultats des études cliniques de phase III : Effets glycémiques, pondéraux et tensionnels

Inhibitors of cotransporter 2 sodium-glucose (i-SGLT2), a new therapeutic class of oral antidiabetic agents (OAD), arrive on the market in France with the expected launching in 2015 of empagliflozin, dapagliflozin, and canagliflozin. Their mechanism of action is independent of insulin secretion and sensibility, and allows an average HbA1c improvement of -0.70%, without any intrinsic hypoglycemic risk. There is an equivalent additive effect at any stage of the disease : in naïve patient, or on add-on to any previous OAD in bi- or tritherapy or with insulin, with a special interest, thanks to its potency on postprandial hyperglycemia. Their HbA1c lowering effect seems equivalent for all molecules, and the magnitude of additive effect of SGLT1 receptor blockage need to be evaluated. This magnitude effect depends linearly of baseline HbA1c level, and decrease in parallel with the decline of renal function. Their durability of action is better than those of sulfonylureas (SU), so their HbA1c lowering effect becomes better than SU after 2 years treatment's duration. It is equivalent to metformin and slightly better than DPP4 inhibitors. Moreover, i-SGLT2 are able to reduce weight by 2kg, and systolic and diastolic blood pressure by 4 and 2mmHg respectively.