[SGLT2 inhibitors : on the borders of diabetology, cardiology, nephrology and… primary care].

Abstract

Sodium-glucose cotransporter type 2 inhibitors (SGLT2is or gliflozins) are now considered as a therapeutic breakthrough in clinical practice, not only for the management of type 2 diabetes (T2D), but also for the treatment of heart failure and chronic renal disease. Patients with T2D are exposed to a higher risk of atheromatic lesions, heart failure and renal insufficiency, all complications that can be reduced by a gliflozin as shown in several placebo- controlled randomised trials in at high risk patients. Unexpectedly, such cardio-renal protection has also been observed among non-diabetic patients with heart failure (both with reduced and preserved ejection fraction) or with chronic kidney disease (especially with albuminuria). Because of these properties, SGLT2is now occupy a privileged place in diabetology, cardiology and nephrology. However, they are still slow to settle in primary care practice, even in high risk patients who should benefit, an underuse possibly due at least partially to quite complex reimbursement criteria in Belgium.