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The role of the kidney and emerging novel therapies in diabetes
Diabetes is increasing at an alarming rate in Indonesia and all across the world
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Diabetes is increasing at an alarming rate in Indonesia and all across the world.
People with poorly controlled diabetes are at increased risk of developing potentially serious and life-threatening complications such as kidney failure, stroke, heart disease and blindness.
Fortunately, with the right medical and lifestyle management, these complications can be prevented.
Though exercise and diet are one of the cornerstones of diabetes management, more than 80 percent of people with diabetes will eventually need some form of medical therapy to keep their sugar levels under control.
At present, there are numerous medications available for the treatment of people with type-2 diabetes, including oral medications and injectable treatments.
These treatments work in various ways to address high blood sugar, such as by increasing insulin release into the bloodstream, enabling the muscles and other parts of the body to take up sugar more effectively and reducing the amount of sugar absorbed from the intestines.
Despite the various medical therapies that are available, many people still suffer from diabetes complications as a result of high sugar levels. It is clear that more agents that can help to reduce blood sugar levels are needed.
Hopefully in the near future, there will be a new novel class of drug for type-2 diabetic patients available in Indonesia: sodium glucose cotransporter-2 (SGLT-2) inhibitors.
These drugs work in a different way from other medications to reduce blood sugar, i.e., by blocking a glucose transporter called SGLT-2 in the kidney and causing the body to remove more glucose from urine.
It is well known that the kidneys play a crucial role in regulating the water and electrolytes (such as sodium and potassium) in the system and also removing the toxins from our body. However, an often-overlooked fact is that the kidney plays a very important role in sugar balance as well.
The kidney is involved in sugar balance via several mechanisms. One of the most important mechanisms lies in the reabsorption of sugar from the urine back into the bloodstream.
When we eat food, sugar is absorbed into our bloodstream and then distributed across the body to important organs such as the brain, which then converts this sugar into energy.
However, a substantial proportion of this sugar passes through the kidney when it is filtered.
Up to 180 grams of sugar (that's four-and-a-half cans of soda) are filtered through the kidneys every day.
In a healthy person, almost all the sugar is reabsorbed back into the body. This process of sugar reabsorption is enabled via a special 'gate mechanism' called the sodium glucose co-transporter.
The active ingredient in SGLT-2 inhibitors is very similar to a compound called phlorozin, which can be found in the root bark of the apple tree.
While scientists have known about phlorozin since the early 1800s, its potential sugar reducing effects have only been used for medicinal purposes only very recently.
Simply put, these novel agents work by inhibiting the SGLT-2, which is responsible for the reabsorption of sugar in the kidney.
By inhibiting SGLT-2, sugar that enters the kidney from the body passes through the urine without being reabsorbed back into the bloodstream.
That way, an individual on SGLT-2 treatment 'loses' sugar from the kidney and in that way, benefits from a lower blood sugar level in their body.
This way, not only does the individual's own sugar level drop (as it is passes out via urine) but it has the added advantage of weight loss, as the accompanying calories in the sugar are similarly passed out in the urine.
Scientific studies have shown patients on SGLT-2 inhibitors have better sugar control with the added benefit of weight loss and a drop in their blood pressure. In addition , as the drug does not increase insulin activity in the body, SGLT-2 inhibitors have not been found to cause hypoglycemia, or low blood sugar.
Furthermore, SGLT-2 inhibitors can be used safely in combination with many other diabetic agents without cross reaction.
However, some participants in clinical trials reported some problems with genital infections ' likely as a result of the high sugar content of their urine.
SGLT-2 inhibitors have potential to aid clinicians in the battle against diabetes mellitus. It has been proven to be effective in lowering HbA1c levels and is a welcome addition to the current array of therapies available.
Despite the potential benefits of this form of therapy, this treatment may not be suitable for all people who have diabetes so please consult your doctor to discuss on whether this is a suitable drug for you.
In summary, SGLT-2 inhibitors are a new medication for sugar control which can be used on its own or in combination with current drugs, which shows much promise. It has been approved in Europe where it is currently being prescribed.
This drug may be available in Indonesia as early as Q1 2015. If you need more information please do speak more to your doctor.
Just like any new drug in diabetes, its long term effects are still under surveillance though it appears to be an effective option in managing blood glucose
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The writer, a physician, is vice president of the Diabetic Society of Singapore and has been cited in more than 100 scientific articles. For more information, visit arden.com.sg.
