Nature Middle East | House of Wisdom

“Revolutionary” type 2 diabetes therapy to be released soon

SGLT2 diabetes

Boehringer Ingelheim

A new class of diabetes therapy, soon to be available on the markets, including in the UAE and Saudi Arabia, is the first to target the kidney, say experts, and is hailed as “revolutionary” by Boehringer Ingelheim, the pharmaceutical producing it.

The modus operandi of the treatment, targeting type 2 diabetes (T2D), was revealed to the press during Dubai’s Arab Health conference last week – and it works by targeting glucose directly, independent of impaired ß-cell function and insulin pathways.

T2D is the most common of the two types of the disease accounting for 90% of diabetes cases and affecting approximately 382 million worldwide – 36.8 million of which are based in the Middle East and North Africa, a number that is expected to double by 2035. This type is marked by high blood glucose levels over a long period, reduced ability of the pancreas to produce insulin, and insulin’s inability to lower blood glucose.

Diabetics, with poorly controlled T2D, have very high renal threshold for glucose reabsorption in their kidneys. The novel treatment inhibits sodium glucose co-transporters (SGLTs) – proteins responsible to the kidneys’ role in reabsorbing glucose into the bloodstream. Specifically, it blocks SGLT2, which reabsorbs 90 % of glucose filtered by the kidney.

Al Sifri describes SGLT2 inhibition as a breakthrough therapy, with few side effects.

Al Sifri describes SGLT2 inhibition as a breakthrough therapy, with few side effects.

Through reducing reabsorption of glucose into the bloodstream, the SGLT2 inhibitor allows excess glucose to pass through the urine, leading to urinary glucose excretion. It’s one of the few treatments available that also guarantees loss of weight, besides regulating blood glucose. It also has a positive effect on blood pressure.

So far, when prescribing this medication, the primary side effects that doctors should look out for are hypoglycaemia (low blood sugar levels) and urinary tract and genital infections, explains Saud Al Sifri, chairman of the endocrinology, and diabetes department at Al Hada Armed Forces Hospitals, Saudi Arabia. Al Sifri, a proponent of the drug, however explains that so early in its introduction, it’s unclear what long-term effects the medication could have on the kidney or otherwise. “We’re not aware of long-term complications,” he says.

Al Sifri explains that considering diabetes is “very complicated; a disease with different faces, and with many subsets,” new classes of treatment provide a range of viable options, since patients require different sets of treatment and drug combinations, especially if the disease progresses. “There are no templates when it comes to diabetes,” he adds.

“It’s FDA-approved. [And ] the risks are very low with this one, as far as we know,” he adds. “It has a different mode of mechanism; other medications work through the pancreas, namely beta and alpha cells. This is the first therapy that cures diabetes through the kidney.”

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