Place des inhibiteurs des SGLT2 dans le traitement du patient diabétique de type 2

Sodium-glucose cotransporter type 2 (SGLT2) inhibitors (SGLT2i; gliflozins) exert their glucose-lowering effect by enhancing glucosuria. Beyond improving glucose control, they are associated with other metabolic and haemodynamic effects that are potentially beneficial. Empagliflozin (EMPA-REG OUTCOME) and canagliflozin (CANVAS) have shown significant reductions in major cardiovascular events, hospitalisation for heart failure and renal outcomes in patients with type 2 diabetes and high cardiovascular risk. Dapagliflozin (preliminary positive effects reported in the observational CVD-REAL registry) is currently evaluated in the DECLARE-TIMI 58 cardiovascular outcome trial. Gliflozins may be used in combination with metformin or a sulphonylurea, in triple oral therapy or in combination with basal insulin according to recent international guidelines. They should most probably be preferred in patients with established cardiovascular disease, at high risk of heart failure and/or with mild renal impairment. Their use is contra-indicated in case of more severe renal insufficiency and in patients with recurrent urinary or genital infections. As they as not commercialized in France yet, SGLT2i were not included in the position statement published by the French-speaking diabetes society (SFD) late 2017. This article analyses the different potential and preferential uses of SGLT2i according to recent data of evidence-based medicine and the clinical experience in French-speaking countries where they are already available.