The role of the kidneys in glucose homeostasis: Mechanisms of effectiveness of sodium-glucose cotransporter type 2 inhibitors

The kidneys are a key organ that supports glucose homeostasis in the body. The most important and clinically interesting glucose transporters at the renal level are type 1 sodium-glucose cotransporters (SGLT1) and type 2 (SGLT2). Their adequate work in conditions of euglycemia ensures complete reabsorption of glucose by the kidneys. However, with type 2 diabetes mellitus (T2DM2), it is necessary to inhibit the action of these transporters. Thus, SGLT2 inhibitors (iSGLT2) provide a decrease in blood glucose levels due to glucosuria. Simultaneously with glucosuria, natriuresis occurs, which provides a decrease in the activity of the systemic and renal renin-angiotensin-aldosterone system, a decrease in the severity of the sympathetic nervous system, a decrease in blood pressure, a decrease in the severity of interstitial edema, which together determines the cardioprotective and nephroprotective effects of iSGLT2. Therefore, iSGLT2 should be prescribed to all patients with T2DM2 and the presence of chronic kidney disease (CKD) and/or cardiovascular diseases (CVD). Moreover, data from clinical studies, as well as modern clinical recommendations, dictate the need to prescribe drugs from this group for CKD without T2DM2 and for heart failure without T2DM2.

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