#279 – AMA #53: Metabolic health & pharmacologic interventions: SGLT-2 inhibitors, metformin, GLP-1 agonists, and the impact of statins | The Peter Attia Drive

Intro

In this episode of “The Peter Attia Drive,” Peter Attia discusses pharmacologic tools to improve metabolic health, including SGLT2 inhibitors, metformin, and GLP1 agonists. He also explores the relationship between statins and insulin resistance and the net benefit versus net harm of these interventions. Listeners’ questions on the topic are addressed, providing valuable insights into managing metabolic disease.

Main Takeaways

Exploring Pharmacologic Interventions

• Metabolic disease is one of the four horsemen of disease, along with cardiovascular disease, neurogenitive disease, and cancer.
• SGLT2 inhibitors, such as Canagliflozin, Dapagliflozin, Empagliflozin, and Ertugliflozin, are glucose-lowering drugs used to treat type 2 diabetes.
• Blocking SGLT2 prevents glucose reabsorption, increasing glucose in the urine and potentially leading to weight loss and blood pressure reduction.
• SGLT2 inhibitors may have geroprotective benefits and show promise in reducing major adverse cardiac events and improving heart failure patients.

Understanding SGLT2 Inhibitors

• SGLT2 stands for sodium glucose-co-transporter protein 2, which is involved in glucose reabsorption in the kidneys.
• These inhibitors were inspired by the naturally occurring substance called Floresine, found in apples, which induced glucose in urine.
• There are currently four SGLT2 inhibitors on the market, all ending in “flosin,” with varying potency and dosing.
• Patients with heart failure have better outcomes when taking SGLT2 inhibitors, even without type 2 diabetes.

Metformin and Statins

• Metformin, a commonly prescribed drug for type 2 diabetes, is associated with weight loss and blood pressure reduction.
• Statins, commonly used to lower cholesterol, may have an impact on insulin resistance and metabolic health.
• Nature has provided pharmacologists with a head start in drug development, with many naturally occurring substances serving as inspiration.
• Drug companies give difficult trade names to ensure brand recognition even after the drug goes off patent.

Summary

Exploring Pharmacologic Interventions

Metabolic disease, a significant health concern, can be effectively managed through pharmacologic interventions. SGLT2 inhibitors, such as Canagliflozin, Dapagliflozin, Empagliflozin, and Ertugliflozin, offer glucose-lowering benefits for individuals with type 2 diabetes. These inhibitors not only help regulate blood sugar levels but also contribute to weight loss and blood pressure reduction. Additionally, they show promise in reducing major adverse cardiac events and improving heart failure patients. By understanding the potential of these interventions, individuals can take proactive steps towards better metabolic health.

Understanding SGLT2 Inhibitors

SGLT2 inhibitors play a crucial role in glucose reabsorption in the kidneys. Inspired by the naturally occurring substance Floresine, these inhibitors prevent glucose from being reabsorbed, leading to increased glucose in urine. This mechanism aids in weight loss and blood pressure reduction. Moreover, SGLT2 inhibitors have shown positive outcomes in heart failure patients, even in the absence of type 2 diabetes. By harnessing the potential of SGLT2 inhibitors, researchers and healthcare professionals can explore new avenues for improving metabolic health and overall well-being.

Metformin and Statins

Metformin, a widely prescribed drug for type 2 diabetes, offers multiple benefits beyond glycemic control. It is associated with weight loss and blood pressure reduction, making it an effective first-line treatment option. On the other hand, statins, commonly used to lower cholesterol levels, have implications for insulin resistance and metabolic health. Nature has provided valuable substances, such as metformin and statins, which serve as inspiration for drug development. By leveraging these naturally occurring compounds, researchers can enhance pharmacologic interventions and improve metabolic health outcomes.

Conclusion

Understanding the role of pharmacologic interventions in metabolic health is crucial for individuals and healthcare professionals alike. SGLT2 inhibitors, metformin, and statins offer promising avenues for managing metabolic disease and improving overall well-being. By exploring the potential benefits of these interventions, individuals can make informed decisions about their health and work towards achieving optimal metabolic health.