4 May 2018

Take 6: Drug that will revolutionise diabetes

Cardio Clinical Diabetes

There is little evidence that most diabetes drugs, including metformin, sulfonylureas, and DPP-4 Inhibitors (gliptins), lower cardiovascular mortality in people with diabetes.

GLP1 agonists have some benefit in terms of lowering the number of deaths from cardiovascular disease in people with diabetes, but the medication’s benefits took “quite some time to accrue”, says Professor Andrew Sindone, the director of heart failure and department of cardiac rehabilitation at Concord Hospital.

“The big revolution in managing diabetes and improving cardiovascular mortality happened in September 2015 when the SGLT2 Inhibitors in the EMPA-REG OUTCOME study showed a huge improvement in mortality,” he says.

This study used empagliflozin, which is a drug that causes glycosuria.

People on this drug lose about the equivalent of 18 sugar cubes in the urine every day.

They lose weight, their blood pressure comes down, their heart rate lowers, they get a 38% reduction in cardiovascular mortality and a 27% reduction in overall mortality, says Professor Sindone.

“This is the first time ever that any diabetic medication has shown such huge benefits,” he says.

“And it’s not really driven by the glucose. The HbA1c comes down a little but the benefit seems to be cardiovascular. I tell people this is a cardiovascular drug, it just happens to lower blood glucose.

“A lot of diabetes medications, including insulin, make people put on weight. So this is going to revolutionise diabetes.”

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2 Comments on "Take 6: Drug that will revolutionise diabetes"

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John Barr
John Barr
9 months 11 days ago
Hear, Hear Andrew McIntyre My patients said “Why not just eat less sugar in the first place?” More common sense in patients than in the drug companies. Have the figures for empaglifozin been compared to someone going on a low carbohydrate diet, and metaphorically not eating the 16 cubes of sugar. Low carb diets could mean you get rid of a lot more than 16 cubes of sugar and don’t run the risk of the significant adverse reactions. Incidentally, the most common one noted is urinary tract infection and what would appear to be urogenital fungal infections, no doubt caused… Read more »
Andrew McIntyre
9 months 14 days ago

Strangely enough you can get those benefits when you exclude those 16 sugar cubes from your diet rather than actually eat them!