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SGLT-2 inhibitors for people with type 2 diabetes

(2019) The Lancet. 394.
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Organization
Abstract
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) seem promising for the prevention and treatment of cardiovascular disease, as shown in a study by Zelniker and colleagues. They are now suggested as secondline therapy for most patients with type 2 diabetes. However, important questions remain open for an important patient group, older patients (particularly those older than 80 years). There is strong evidence that SGLT2i can prevent heart failure, both incident and worsening. Heart failure is progressively a geriatric syndrome, with an estimated 60% increase in individuals older than 80 years until 2030; however, octogenarians have not been adequately represented in SGLT2i trials. SGLT2i also appear to be beneficial for patients with poor renal function, which might be reassuring because for many drug treatments you are as old as your kidneys. However, it is still not clear how safe SGLT2i actually are in older patients, particularly those with frailty, multimorbidity, volume depletion, hypotension, and weight reduction, in addition to kidney dysfunction. Another important question is whether SGLT2i can prevent both systolic (reduced ejection fraction) and diastolic (preserved ejection fraction; especially prevalent in older patients) heart failure. So far, the two types have not been differentiated in large SGLT2i trials. It is possible that SGLT2i will be of major interest also in geriatric patients at risk of heart failure, with and without type 2 diabetes. At the moment, systematical expansion of the study and evaluation of SGLT2i in all age groups, including older people, is needed. Specifically, aiming to study older people with multimorbidity, frailty, and polypharmacy will close the knowledge gaps, which will ultimately enable personalised medicine approaches.
Keywords
Sodium-glucose co-transporter-2 inhibitors, type 2 diabetes

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Chicago
Strandberg, Timo E, Mirko Petrovic, and Athanase Benetos. 2019. “SGLT-2 Inhibitors for People with Type 2 Diabetes.” The Lancet 394: 560.
APA
Strandberg, T. E., Petrovic, M., & Benetos, A. (2019). SGLT-2 inhibitors for people with type 2 diabetes. The Lancet, 394, 560.
Vancouver
1.
Strandberg TE, Petrovic M, Benetos A. SGLT-2 inhibitors for people with type 2 diabetes. The Lancet. 2019;394:560.
MLA
Strandberg, Timo E, Mirko Petrovic, and Athanase Benetos. “SGLT-2 Inhibitors for People with Type 2 Diabetes.” The Lancet 394 (2019): 560. Print.
@article{8625172,
  abstract     = {Sodium-glucose co-transporter-2 inhibitors (SGLT2i) seem promising for the prevention and treatment of cardiovascular disease, as shown in a study by Zelniker and colleagues. They are now suggested as secondline therapy for most patients with type 2 diabetes. However, important questions remain open for an important patient group, older patients (particularly those older than 80 years). There is strong evidence that SGLT2i can prevent heart failure, both incident and worsening. Heart failure is progressively a geriatric syndrome, with an estimated 60% increase in individuals older than 80 years until 2030; however, octogenarians have not been adequately represented in SGLT2i trials. SGLT2i also appear to be beneficial for patients with poor renal function, which might be reassuring because for many drug treatments you are as old as your kidneys. However, it is still not clear how safe SGLT2i actually are in older patients,
particularly those with frailty, multimorbidity, volume depletion, hypotension, and weight reduction, in addition to kidney dysfunction. Another important question is whether SGLT2i can prevent both systolic (reduced ejection fraction)
and diastolic (preserved ejection fraction; especially prevalent in older patients) heart failure. So far, the two types have not been differentiated in large SGLT2i trials. It is possible that SGLT2i will be of major interest also in geriatric patients at risk of heart failure, with and without type 2 diabetes. At the moment, systematical expansion of the study and evaluation of SGLT2i in all age groups, including older people, is needed. Specifically, aiming to study older people with multimorbidity, frailty, and polypharmacy will close the knowledge gaps, which will ultimately enable personalised medicine approaches.},
  author       = {Strandberg, Timo E and Petrovic, Mirko and Benetos, Athanase},
  issn         = {0140-6736},
  journal      = {The Lancet},
  keywords     = {Sodium-glucose co-transporter-2 inhibitors,type 2 diabetes},
  language     = {eng},
  title        = {SGLT-2 inhibitors for people with type 2 diabetes},
  url          = {http://dx.doi.org/10.1016/s0140-6736(19)30719-6},
  volume       = {394},
  year         = {2019},
}

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