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Paper Chase #4 - Canagliflozin and Renal Outcomes in T2DM and Nephropathy

Steve Biederman, MD and Tom Robertson, MD
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In patients with DM2 and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group. 

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Irvin S. -

Given the very modest A1c reduction with Invokana, by what mechanism does it reduce CV risk? Is this a class effect? Is it independent of its seemingly very modest effect on Type 2 diabetes?

Neda F., MD -

What's known about it so far seems to be class effect of the SGLT2 inhibitors and is attributed to the natriuresis, volume contraction, & reduction in preload, blood pressure, and afterload as a few possible mechanisms. Here are a few articles that discuss the mechanisms of CV risk reduction: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846470/ and https://link.springer.com/article/10.1007%2Fs00125-018-4670-7 -- Neda

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Are We Better in the Morning? Full episode audio for MD edition 188:54 min - 88 MB - M4APrimary Care RAP September 2019 Written Summary 580 KB - PDF