Diabetes Update A Focus on SGLT-2 Inhibitors- Pharmacist
The number of people affected by diabetes worldwide is growing rapidly. A 2014 national report estimates that 21 million people in the United States have diabetes and another 8.1 million people remain undiagnosed. All together, that is 9.3% of the US population. Around the world, 387 million people have diabetes, - which accounts for 8.3% of the global population. This burden is expected to increase by 205 million people by 2035. Despite advances in technology and drug therapy, many patients do not achieve adequate glycemic control. National guidelines generally recommend hemoglobin A1c (A1C) values less than 6.5-7%. However, the A1C goal should be individualized based on the patient's specific circumstances. The National Committee for Quality Assurance (NCQA) reported that in 2013, only 52-59% of adults with type 1 or type 2 diabetes who had commercial insurance had A1C levels less than 8%. For Medicaid patients, the percentage was even lower at 45.5%. Expert guidelines generally recommend dual therapy (metformin plus another agent) for patients with A1C values over 7.5%. If the A1C goal has not been achieved after 3 months of dual therapy, progression to triple therapy is recommended. Preferred options (in addition to metformin) for dual therapy include glucagon-like peptide-1 (GLP-1) agonists, sodium glucose transporter-2 (SGLT-2) inhibitors, and dipeptidyl peptidase- 4 (DPP-4) inhibitors. Since about half of the patients with diabetes in the community are not achieving adequate glycemic control, pharmacists have an excellent opportunity to impact and improve their care. They can advocate for medication changes to achieve optimal glycemic control and educate patients about diabetes goals, medication side effects, administration, and potential drug interactions. SGLT-2 inhibitors are the newest class of diabetes medications, with 3 agents available: canagliflozin (Invokana®), dapagliflozin (Farxiga®), and empagliflozin (Jardiance®). This article will prepare community practitioners to support and educate patients who are already taking these medications, and recommend or initiate their use for patients who are good candidates.