Comprehensive review of SGLT2 inhibitors' efficacy through their diuretic mode of action in diabetic patients.

SGLT2 inhibitors (SGLT2i) are now the mainstay therapy for both diabetes and heart failure. Post-hoc publications, meta-analysis, and conference presentations of the eight SGLT2i Cardiovascular Outcomes trials (CVOTS) done in diabetic patients constantly echo that this class of drug decreases mortality, reduces cardiovascular events, and prevents heart failure and kidney disease. This review of medical agencies' SGLT2i analysis (FDA and EMA) helps to understand the reality of SGLT2i results in those trials, avoiding to consider observational and statistically undemonstrated endpoints as validated. They also confirmed the unique diuretic mode of action of SGLT2i, promoting osmotic diuresis, and its potential adverse events secondary to hypovolemia and hematocrit increase. They also support the understanding that the beliefs in SGLT2i morbi-mortality benefits are largely overstated mostly based on undemonstrated endpoints. Finally, it is clear that SGLT2i's antidiabetic action, secondary to its renal mode of action, plateaued after a few months and decreased strongly over time, questioning its long-term goal of maintaining diabetic patients' HbA1c below 7%. Also, this effect in patients with renal impairment is quasi null. We think that this review would be very helpful to every physician treating diabetic patients to better balance belief and reality of SGLT2i prescription effects.

Efecto diurético de la tintura al 50 por ciento de Varronia globosa Jacq (yerba de la sangre) en ratas / Diuretic activity of 50 percent tinction from Varronia globosa Jacq (yerba de la sangre) in rats

Introducción: en la medicina tradicional de Cuba se usa la decocción de las hojas frescas de la planta conocida como yerba de la sangre (Varronia globosa Jacq) por sus efectos beneficiosos sobre las afecciones renales y como antihipertensivo; sin embargo, no existen estudios preclínicos que demuestren este efecto y validen su uso. Objetivo: determinar la actividad diurética de la tintura al 50 por ciento de las hojas y ramas de V globosa. Métodos: se utilizaron 40 ratas machos de la línea isogénica Wistar, de peso corporal promedio de 260 g, asignadas a 4 grupos de trabajo (n= 10) de forma aleatoria. Los resultados fueron comparados con furosemida 20 mg/kg de peso y con cloruro de sodio al 0,9 por ciento utilizado como control negativo. Los grupos experimentales fueron tratados con tintura al 50 por ciento, preparada de las hojas y ramas de V globosa en dosis de 25 y 50 mg/kg. La excreción urinaria se midió a las 24 h y se midió la concentración de cloro, sodio y potasio. Resultados: a las 24 h, los volúmenes acumulados de orina en los grupos que recibieron tintura de V. globosa a dosis de 50 mg/kg, tuvieron un comportamiento similar al grupo control positivo (furosemida) y resultaron significativamente diferentes del control negativo (cloruro de sodio 0,9 por ciento). La tintura de V globosa demostró tener efecto natriurético a la dosis de 50 mg/kg. Conclusiones: la tintura al 50 por ciento de V. globosa, conocida tradicionalmente como yerba de la sangre, mostró actividad diurética a dosis de 50 mg/kg por vía oral

Introduction: decoction of fresh leaves from a well-known plant called yerba de la sangre (Varronia globosa Jacq.) is used in Cuba due to its beneficial effects for treating renal and hypertensive disorders; however, there is no preclinical study to prove this action and to validate its use. Objective: to determine the diuretic activity of 50 percent tincture from leaves and branches of V globosa. Methods: forty Wistar male rats weighing 260 g each as average were randomly assigned to 4 working groups (n= 10). The results were compared to those of furosemide at a dose of 20 mg/kg, and of 0,9 percent sodium chloride as negative control. The experimental groups received 50 percent tincture from leaves and branches of V globosa at doses of 25 and 50 mg/kg. The urinary excretion was measured at 24 hours; additionally, chloride, sodium and potassium concentrations were considered. Results: after 24 hours, the urine volumes in the groups that received tinction from V globosa at a dose of 50 mg/kg behaved similarly to the positive control group (furosemide) and significantly different from the negative control group (0.9 percent sodium chloride). V globosa tincture proved to have natriuretic effect at 50 mg/kg dose. Conclusions: 50 percent tincture from V. globosa, traditionally known as yerba de la sangre, showed diuretic action at 50 mg/kg orally administered dose

Efecto diurético de la tintura al 50 por ciento de Varronia globosa Jacq (yerba de la sangre) en ratas / Diuretic activity of 50 percent tinction from Varronia globosa Jacq (yerba de la sangre) in rats

Introducción: en la medicina tradicional de Cuba se usa la decocción de las hojas frescas de la planta conocida como yerba de la sangre (Varronia globosa Jacq) por sus efectos beneficiosos sobre las afecciones renales y como antihipertensivo; sin embargo, no existen estudios preclínicos que demuestren este efecto y validen su uso. Objetivo: determinar la actividad diurética de la tintura al 50 por ciento de las hojas y ramas de V globosa. Métodos: se utilizaron 40 ratas machos de la línea isogénica Wistar, de peso corporal promedio de 260 g, asignadas a 4 grupos de trabajo (n= 10) de forma aleatoria. Los resultados fueron comparados con furosemida 20 mg/kg de peso y con cloruro de sodio al 0,9 por ciento utilizado como control negativo. Los grupos experimentales fueron tratados con tintura al 50 por ciento, preparada de las hojas y ramas de V globosa en dosis de 25 y 50 mg/kg. La excreción urinaria se midió a las 24 h y se midió la concentración de cloro, sodio y potasio. Resultados: a las 24 h, los volúmenes acumulados de orina en los grupos que recibieron tintura de V. globosa a dosis de 50 mg/kg, tuvieron un comportamiento similar al grupo control positivo (furosemida) y resultaron significativamente diferentes del control negativo (cloruro de sodio 0,9 por ciento). La tintura de V globosa demostró tener efecto natriurético a la dosis de 50 mg/kg. Conclusiones: la tintura al 50 por ciento de V. globosa, conocida tradicionalmente como yerba de la sangre, mostró actividad diurética a dosis de 50 mg/kg por vía oral(AU)

Introduction: decoction of fresh leaves from a well-known plant called yerba de la sangre (Varronia globosa Jacq.) is used in Cuba due to its beneficial effects for treating renal and hypertensive disorders; however, there is no preclinical study to prove this action and to validate its use. Objective: to determine the diuretic activity of 50 percent tincture from leaves and branches of V globosa. Methods: forty Wistar male rats weighing 260 g each as average were randomly assigned to 4 working groups (n= 10). The results were compared to those of furosemide at a dose of 20 mg/kg, and of 0,9 percent sodium chloride as negative control. The experimental groups received 50 percent tincture from leaves and branches of V globosa at doses of 25 and 50 mg/kg. The urinary excretion was measured at 24 hours; additionally, chloride, sodium and potassium concentrations were considered. Results: after 24 hours, the urine volumes in the groups that received tinction from V globosa at a dose of 50 mg/kg behaved similarly to the positive control group (furosemide) and significantly different from the negative control group (0.9 percent sodium chloride). V globosa tincture proved to have natriuretic effect at 50 mg/kg dose. Conclusions: 50 percent tincture from V. globosa, traditionally known as yerba de la sangre, showed diuretic action at 50 mg/kg orally administered dose(AU)

Diuretic Potential of Whole Plant Extracts of Pergularia daemia (Forsk.).

The whole plant, Pergularia daemia (Family: Asclepediaceae), was extracted with 50% alcohol and a fresh batch of the plant material was successively extracted with petroleum ether, ethyl acetate and n-butanol to determine its diuretic activity. The diuretic activity of the different extracts at a dose of 400 mg/Kg was assessed orally in rats with furosemide as a standard drug using Lipschitzs test. All extracts except the petroleum ether extract showed significant increase (p < 0.001) in urine output. Urinary electrolyte excretion was also affected by the extracts: the alcoholic, ethyl acetate and n-butanol extract caused an increase in the urinary excretion of sodium and potassium ions. These findings suggest that among the mentioned extracts, ethanolic has the maximum diuretic activity followed by n-butanol extract.

Pharmacological Studies on Liniao Capsules / 中成药

Objective:To observe the diuretic action of Liniao Capsules (LC). Methods: The urinary effects of LC were studied in the loading rats with water.Results: LC could significantly increase the urinary output, shorten the latent period of emiction, and reduce the contents of TP in urine and BUN in blood serum. Conclusion: LC exerted the significant diuretic effect in rats.