Sodium-glucose co-transporter 2 inhibitor (SGLT2i) precursors were discovered in 1835 and glycosuric effects confirmed in 1886. Subsequently, there have been four paradigm shifts in the use of SGLTIs as eloquently summarised by Eugene Braunwald (1). These medicines reduced cardiovascular mortality and development of heart failure in patients with type 2 diabetes (T2DM) and cardiovascular disease (2–4). Additionally, similar benefits were seen in patients with heart failure (reduced and preserved ejection fraction), irrespective of diabetes, and in patients with chronic kidney disease (5–9). The benefits and optimal initiation of SGLTIs in patients with acute coronary syndrome (ACS) are still not proven. Could this represent the fifth paradigm shift in the use of SGLTIs?
Author Heartbeat Sub-Editor: Dr Khin Kay Kay Kyaw I am currently working as cardiology specialist registrar ST6 at southwest peninsula region while also working as
Author Sub-editor: Dr Pok-Tin Tang Dr Pok-Tin Tang is an ST5 cardiology registrar in the Thames Valley deanery, currently undertaking a period of out of
Author Sub-editor: Dr May Hu Dr May Hu is a cardiology trainee in the North West deanery. She graduated with First Class Honours from the University
Author Sub-editor: Dr Jhiamluka Solano Dr Jhiamluka Solano is a cardiology resident doctor (ST6) in the Yorkshire and Humber Deanery, currently undertaking a DPhil (PhD)