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    Diabetes Mellitus Type 2, effects of SGLT-2 inhibitors
    Thorsdottir, Ragnheidur Anna; Juhász, Béla; Debreceni Egyetem::Általános Orvostudományi Kar::Farmakológiai és Farmakoterápiai Intézet; DE--Általános Orvostudományi Kar; Kiss, Rita; Kurucz, Andrea; Debreceni Egyetem::Általános Orvostudományi Kar::Farmakológiai és Farmakoterápiai Intézet; Debreceni Egyetem::Általános Orvostudományi Kar::Kardiológiai Intézet
    Type 2 diabetes mellitus (T2DM) is a serious and rising public health crisis. An estimated 463 million people are living with this condition in the world in 2019 and the number is expected to rise dramatically in the coming decades. The complications of T2DM cause significant morbidity and mortality and without appropriate intervention will cause significant strain on healthcare systems around the world. The pathogenesis of T2DM is a combination of hereditary factors, lifestyle and environmental factors that lead to peripheral insulin resistance and metabolic dysregulation of glucose and lipids. The chronic complications of diabetes involve both the micro and the microvasculature, affecting practically all systems of the body thus it is important to effectively treat hyperglycemia as it is at the heart of the development of these complications. There are various drug classes available, which are used either in monotherapy or polytherapy. They can be classified as insulinotropic e.g., sulfonylurea, GLP-1 agonists, or non-insulinotropic e.g., metformin, SLGT-2 inhibitors. SGLT-2 inhibitors act on the proximal nephron in the kidney inhibiting glucose reabsorption and, in this way, lower the glucose concentration in the blood. Several large studies have been done in recent years to investigate the effect of SLGT-2 inhibitors on the progression of the chronic complications of T2DM. The results of the EMPA-REG OUTCOME trial, CANVAS program, CREDENCE trial, VERTIS CV outcome study, DECLARE-TIMI 58 trial and DAPA-HF trial were analyzed, and the conclusions drawn from these was that SGLT-2 inhibitors have cardio- and nephroprotective properties that cannot be solely explained by their glucose lowering effect. This suggests that there is a separate, unknown mechanism at work that there is reason to investigate further.