By: Dr. Barry Horowitz
Many of you have seen the commercials on television about the new medications to treat Type 2 Diabetes that work in the kidney. I know this, because you are all asking me about it in the office! Well, these are newer and exciting medications, but they must be used in the correct way and in the right patient.
It turns out that the kidney plays a big role in sugar metabolism in our bodies. First of all, sugar is actually made in the kidney, as it is in the liver. In addition, along with filtering waste from our bloodstream, the kidney also filters sugar. However, whereas waste goes out of the body in the urine, all of the sugar that the kidney filters is reabsorbed back into the bloodstream. This is an issue in diabetics whose blood sugars are high, because the kidney simply reabsorbs the extra sugar that it filters back into the bloodstream, adding to the problem.
Scientist have discovered where in the kidney the reabsorption of sugar takes place and have named it the sodium glucose transporter or SGLT. There are 2 of these transporters and the one that is the most active is called SGLT2. So, medications were then designed to block SGLT2 so that sugar is now disposed of in the urine rather than reabsorbed back into the bloodstream, interrupting the viscous cycle. There are now 3 such medications on the market that are approved for use in Type 2 Diabetes: Invokana; Farxiga; and Jardiance.
These medications do a great job reducing blood sugar levels and A1c levels (3 month average sugar). They also have other added benefits. First of all, because patients lose sugar in the urine, they are also losing calories, so they lose weight. In addition, blood pressure levels are reduced.
Of course any medication has side effects, so these have to be monitored. Some people have an increase in thirst and urination. Women and men can have genital yeast infections and there is a higher incidence of urinary tract infections. In addition, certain patients may be prone to having their blood pressure lowered too much.
So, these medications are a nice addition to our “tool box” to treat Type 2 diabetes. They have other beneficial effects as well. However, it is important to discuss whether they may be a good option for you with your physician.