Understanding The Connection Between Diabetes and Kidney Disease: Are SGLT-2 Inhibitors the “Magic Bullet”? BY VALENTINA FERNANDEZ '24
Cover Image: 1916 Schematic of a longitudinal section of a kidney. One of the hallmark symptoms in diabetes mellitus is polyuria, or excessive urination, which results from abnormally high levels of sugar in the blood, causing the kidneys to retain more water. Image Source: Wikimedia Commons
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Introduction Diabetes has been called the epidemic of the century, while kidney disease has been called the under-recognized public health crisis (Kharroubi & Dariwsh, 2015; NVS 2021 report of 2018 data). Kidney disease causes more death than breast cancer or prostate cancer, and diabetes affects over 460 million people worldwide. (Kharroubi & Dariwsh, 2015; NVS 2021 report of 2018 data). But, seldom is the connection between these two considered in-depth. Diabetes is the leading cause of kidney disease, accounting for nearly half of all causes of kidney failure resulting in a kidney transplant (Tuttle et al., 2021). Just in the United States, 34.2 million adults (~10.5% of the population) are thought to have diabetes, with 9095% of cases being type 2 diabetes. It is estimated that the economic burden of diabetes costs the United States about $327 billion USD per year, with reduced productivity accounting for $90 billion of the total, and the rest due to direct medical costs (American Diabetes Association, 2018). Diabetic Kidney Disease (DKD), which is chronic kidney disease for people with diabetes, is estimated to occur in ~30% of people with type 1 diabetes and in ~40% of people with type 2 diabetes (Tuttle et al., 2021). Even though
the interconnectedness of diabetes and kidney disease has long been known, the emergence of a new class of drugs called SGLT-2 inhibitors has reignited interest in addressing DKD. SGLT-2s were originally developed for people with type 2 diabetes to control their glycemia levels. However, they were found to have both positive cardiovascular and renal effects. The development of these drugs provides a promising future for people living with cardiometabolic and renal diseases, such as diabetes, hypertension, and chronic kidney disease. This review article will focus on the connection between diabetes and kidney disease. This paper will begin by providing background on the molecular mechanisms at play in diabetes mellitus and nephropathy (kidney disease). Next, the paper will turn its attention to the postulated reasons why diabetes causes kidney failure. The paper will then transition to review the current interventions in place to mitigate the burden of these disease, with a specific focus on the emergence of SGLT-2 inhibitors. To conclude, this paper will explore the limits of SGLT2 therapy right now, and what we can expect from this class of drugs looking forward.
DARTMOUTH UNDERGRADUATE JOURNAL OF SCIENCE
