SGLT2 Inhibitors: The Latest “New Kids on the Block”!

Everything in the world of diabetes is moving fast these days. Over the last few months, we have received extensive new information regarding the burden of diabetes and suggested changes in treatment strategies. Specifically, in the December 2014 issue of Diabetes Care, we reported startling new statistics about the rising costs associated with diabetes and prediabetes (1). The economic burden associated with diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes was estimated to be 48% higher than that reported in 2007. For 2012, the estimated total burden exceeded $322 billion, comprising $244 billion in excess medical costs and $78 billion in reduced productivity (1). Following the release of these economic statistics there came further proposals regarding strategies for managing diabetes. In the January 2015 issue of Diabetes Care, and coordinated with a release in Diabetologia, there was an update to the 2012 position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) on the management of hyperglycemia (2). A prominent change with respect to treatment options since publication of the 2012 statement concerned the sodium–glucose cotransporter (SGLT) 2 inhibitors. Metformin remains the preferred drug for monotherapy, but based on a rapid accumulation of new information about SGLT2 inhibitors, this new class of agents is included as a reasonable choice for second-line or third-line therapy in the updated statement. Because Diabetes Care has recently received many submissions reporting new data and evolving clinical strategies for SGLT2 blockers, our editorial team has elected to feature this class of agents in this issue of Diabetes Care. The articles presented in this issue describe research related to novel combinations with a dipeptidyl peptidase-4 in-hibitor or with insulin, favorable effects on blood pressure and weight as well as gly-cemic control, and new agents that inhibit both SGLT1 and SGLT2 (3–13). As outlined with the new recommendations from the ADA/EASD and as provided in Fig. 2 of the update (2), there is the suggested option of adding SGLT2 inhibitors to the background of metfor-min or sulfonylurea plus metformin if gly-cemic goals are not met. In this issue, we provide two articles that provide additional information that this option offers added benefit by addressing " unmet " clinical needs, such as weight loss, lipid and blood pressure control, and durability (3,4). In the first study, Leiter et al. (3) assessed the efficacy and safety of cana-gliflozin at doses …