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Are SGLT2 inhibitors safe and effective for people with Type 2?

Project summary

People with Type 2 diabetes can use drugs called SGLT2 inhibitors to help them manage their blood glucose levels. But unanswered questions remain around how effective and safe they are in real life. Dr Thomas Caparrotta will study large amounts of data from people using these drugs in the real world, to provide important evidence on their effects. This will help doctors and people with Type 2 diabetes to make decisions about the best treatment for them.

Background to research

There are a number of different medications available to people with Type 2 diabetes, all of which work in different ways. SGLT2 inhibitors (known as canagliflozin, dapagliflozin and empagliflozin) work by reducing the amount of glucose absorbed by your kidneys. The glucose leaves the body in urine, therefore reducing the amount in your blood. They can be a useful treatment for many people with Type 2 diabetes. But not all medications are suitable for everyone.

Clinical trials are the best way to find out how well a drug works. They’ve shown that SGLT2 are effective. But trials follow strict conditions (e.g. they may only involve particular groups of people with Type 2 diabetes) and so are different from real-world diabetes care.

There are also some unanswered questions about the safety of SGLT2 inhibitors. For example, in rare cases they’ve been linked with diabetic ketoacidosis (DKA): a serious complication of diabetes caused by low insulin levels.

The NHS has large sets of data related to the real-world care of people with Type 2 diabetes, which Dr Caparrotta wants to make use of. It contains information about their health, what medications they’re taking and hospital admissions.

Research aims

Dr Caparrotta will study NHS data from nearly everybody with Type 2 diabetes in Scotland (around 350,000 people). He wants to know if people with Type 2 diabetes treated with SGLT2 inhibitors in the real world have a higher risk of health complications, like DKA, compared to people not taking these drugs. He’ll also look at whether SGLT2 inhibitors are as effective when used in day-to-day life as the results in clinical trials. And if not, why.

He’ll then compare what he’s found with other large datasets from Finland, Sweden and Denmark to gather more evidence.

Potential benefit to people with diabetes

This study will answer important questions about the safety and effectiveness of SGLT2 inhibitors. This could help doctors improve their advice and help people with Type 2 diabetes reach decisions about the best treatment options for them.

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