Explore pharmacologic tools for improving metabolic health and treating diabetes, including SGLT-2 inhibitors, metformin, and GLP-1 agonists. Learn about the potential geroprotective benefits of SGLT2 inhibitors. Analyze the relationship between statin usage and insulin resistance, and strategies for risk reduction. Discover the development and impact of SGLT-2 inhibitors on diabetes treatment. Delve into the potential of SGLT2 inhibitors as geoprotective molecules.
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Quick takeaways
Pharmacologic tools like SGLT-2 inhibitors, metformin, and GLP-1 agonists can improve metabolic health and treat diabetes.
SGLT2 inhibitors have potential as geroprotective agents beyond glycemic control, reducing the risk of heart failure regardless of diabetic status.
Deep dives
Pharmacologic Tools for Improving Metabolic Health
In this Ask Me Anything (AMA) episode, the hosts discuss the various pharmacologic tools available to improve an individual's metabolic health. They focus on SGLT2 inhibitors, Metformin, GLP1 agonists, and other drugs that can enhance metabolic health. The hosts delve into the potential geo-protective benefits of SGLT2 inhibitors and their role in improving metabolic health. Additionally, they explore the relationship between statins, the most prescribed class of drugs, and insulin resistance, covering the broader context of net benefit versus net harm.
Understanding SGLT2 Inhibitors
The hosts provide an overview of SGLT2 inhibitors, starting with the explanation of their acronym, Sodium Glucose Co-Transporter Protein 2. They describe how these inhibitors prevent the reabsorption of glucose in the kidney, leading to its excretion in urine. The hosts discuss how blocking SGLT2 impacts glucose concentration and sodium levels, offering insights into their potential blood pressure-lowering effects. They highlight Canagliflozin as one of the most extensively studied SGLT2 inhibitors and its significant reduction in hemoglobin A1c. Additionally, they touch upon other SGLT2 inhibitors, such as Dapagliflozin, Empagliflozin, and Ipragliflozin.
Exploring the Geo-Protective Potential of SGLT2 Inhibitors
The hosts address the growing interest in the geo-protective effects of SGLT2 inhibitors, particularly among non-diabetic individuals. They discuss how clinical trials have demonstrated the benefits of SGLT2 inhibitors in reducing the risk of hospitalization and death due to heart failure, regardless of diabetic status. The hosts speculate that these benefits may be attributed to the reduction in blood pressure and potential mechanisms beyond glycemic control. They emphasize the excitement surrounding the potential non-diabetic applications of SGLT2 inhibitors and highlight their distinct advantages in improving cardiovascular outcomes.
In this “Ask Me Anything” (AMA) episode, Peter explores various pharmacologic tools commonly utilized to improve metabolic health and treat diabetes, including SGLT-2 inhibitors, metformin, and GLP-1 agonists. He examines the available data on these drugs, assessing their comparative effectiveness and their potential in the context of lifestyle interventions. Additionally, he offers insights into whether SGLT2 inhibitors hold promise as geroprotective agents beyond their effects on glycemic control. Next, Peter analyzes the relationship between statin usage and the risk of developing insulin resistance and type 2 diabetes, investigating possible causal pathways and providing insights into strategies for risk reduction. He offers insights on monitoring adverse statin effects and evaluating the need for adjustments, ultimately weighing the trade-off between the risk to overall metabolic health against the benefits of reducing apoB levels through statin use.
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We discuss:
Pharmacologic tools for improving metabolic health, and the relationship between statins and insulin resistance [2:00];
SGLT-2 inhibitors: how they work and help to manage type 2 diabetes [4:15];
The history of SGLT2 inhibitors – from discovery to the current state [10:15];
Comparing the various FDA-approved SGLT2 inhibitors [15:00];
Other beneficial effects of SGLT2 inhibitors outside of glycemic control [20:15];
Exploring SGLT2 inhibitors as potential geroprotective molecules [22:45];
The side effects and risks associated with SGLT2 inhibitors [31:45];
Medications, lifestyle interventions, and other considerations for treating diabetes and improving metabolic health [37:45];
Metformin as a tool for pre-diabetics, and how metformin compares to lifestyle interventions [44:00];
How GLP-1 agonists compare to metformin and SGLT2 inhibitors in terms of glycemic control and weight loss [49:15];
Exploring the relationship between statin use and the risk of developing insulin resistance and type 2 diabetes [52:30];
Possible mechanisms of statin-induced insulin resistance and diabetes, and potential mitigation strategies [1:04:30];
How to monitor for adverse effects of statin use and assess the need for adjustments [1:11:45];
Weighing the benefits and risks of statin use: does the diabetes risk outweigh the benefits of lowering apoB with a statin? [1:15:30];