Canagliflozin for the treatment of type 2 diabetes.

Canagliflozin, an oral inhibitor of sodium/glucose cotransporter 2 (SGLT2) in the kidneys, leads to glucosuria and provides a unique mechanism to lower blood glucose levels in diabetes. It corrects a novel pathophysiological defect, has an insulin-independent action, reduces HbA1c by 0.5 to 1.1%, promotes weight loss, has a low incidence of hypoglycemia, complements the action of other antidiabetic agents, can be used at any stage of diabetes and appears to be safe in patients with compromised renal function. Due to side effects such as urinary tract and genital infections and decrease in blood pressure, proper patient selection for drug initiation and close monitoring will be important. Results of ongoing cardiovascular safety trials are important to determine the risk-benefit ratio. Canagliflozin is the first oral SGLT2 inhibitor approved in the U.S. market and it represents a promising approach for the treatment of diabetes in this era of increasing obesity.