Australian Prescriber articles on new class of drugs for diabetes

26 NOVEMBER 2013

Australian Prescriber has published a number of articles ‘online first’ to provide prescribers and other health professionals with information on a new class of diabetes drugs – sodium-glucose co-transporter (SGLT) inhibitors. The first two drugs in this class are dapagliflozin (Forxiga) and canagliflozin (Invokana) and on 1 December 2013 both medicines will be listed on the Pharmaceutical Benefits Scheme.

Sodium glucose co-transporter inhibitors: mechanisms of action

Dr Tilenka Thynne of Royal Adelaide Hospital and Dr Matthew Doogue from the University of Otago explain how these new medicines work and explain the adverse effects and risks. According to the authors, SGLT inhibitors lower plasma glucose and reduce the renal reabsorption of urinary glucose. The reduction in plasma glucose is independent of insulin secretion and insulin peripheral resistance. They write that the long-term effects of SGLT inhibitors are unknown.

Sodium-glucose co-transporter inhibitors: clinical applications

Professor Timothy Davis from Fremantle Hospital discusses the likely place of SGLT inhibitors in clinical practice and explains potential safety concerns. He explains that these drugs improve glycaemic control, have a low incidence of hypoglycaemia, and reduce body weight and blood pressure.

The author writes that SGLT inhibitors have the convenience of once-daily dosing and their mechanism of action means that they can be combined safely with other oral glucose-lowering drugs and insulin. The main adverse effects are increases in genitourinary infections, dehydration-related symptoms including postural hypotension, and raised serum low density lipoprotein cholesterol. Ongoing surveillance including large-scale cardiovascular safety trials should provide objective data on the possible increased risk of stroke, fracture and malignancy.

New drugs: canagliflozin

Indicated for type 2 diabetes, canagliflozin is the second sodium-glucose co-transporter inhibitor to be approved in Australia. A summary of the new drug published on the Australian Prescriber website explains that canagliflozin reduces renal reabsorption of glucose, resulting in increased glucose excretion in the urine. The review includes information about the action of the medicine, its efficacy, and a summary of clinical trials. It explains that canagliflozin is most likely to be used as an add-on therapy when type 2 diabetes cannot be controlled by metformin and a sulfonylurea, in addition to diet and exercise. Dapagliflozin was reviewed in Australian Prescriber in October.

To read the full articles and more visit


Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published every two months and distributed to health professionals free of charge, and is also available online at 

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