Risk and Benefits of Canagliflozin, a New Sodium-Glucose Co-Transporter Type 2 Inhibitor, in the Treatment of type-2 Diabetes Mellitus

Anti-diabetic medications are used to control blood sugar levels if diet and exercise fail to do so. On March 29, 2013, canagliflozin became the first SGLT2 inhibitor to be approved in the United States for the treatment of type-2 diabetes. This drug blocks reabsorption of glucose in the proximal tubule, lowering the renal threshold for glucose and thereby increasing glucose excretion. Its novel mechanism of action is insulin-independent. In clinical trials, canagliflozin significantly decreased fasting glucose and HbA1c level when administered either as monotherapy or as combined therapy with other anti-diabetic drugs, with added benefit of weight loss and lowering of blood pressure. It possesses favourable pharmacokinetic and pharmacodynamic profiles. It is administered orally and may be a viable option for adults with Type-2 DM who cannot achieve glycemic control with multiple agents but refuse injectable medications. However, it is not devoid of unfavourable adverse effects like urinary tract infections, genital yeast infections, postural hypotension, hyperkalemia, dose-dependent increases in low-density lipoprotein cholesterol etc. Canagliflozine should not be used in chronic kidney disease due to decreased or lack of efficacy and nephrotoxicity.