Sodium-glucose transport proteins

It appears to have an effect where it pulls glucose into the kidney and basically increases the filtration, the glomerular filtration of glucose.

So it slightly lowers glucose, not as potently as something called an SGLT2 inhibitor, which is a class of drug that does that.

But it's very interesting nonetheless.

So, you know...

So the NICE guidance has actually reflected that.

So what does this mean for us? This would mean that we'd start people on therapies like SGLT2 inhibitors, sodium glucose co-transporters inhibitors, and GLP-1 analogs or glucagon-like peptide analogs much earlier in the treatment pathway.

So the key changes that I would like to talk about are Modified release metformin and SGLT2 inhibitors are started on every patient with type 2 diabetes if there is no contraindication.

And now that's a significant change from what we used to do up until a few months ago, where you start somebody on metformin and escalate treatment depending on their HbA1c.

The other key changes are clinical profiling of people with type 2 diabetes into different categories and managing their diabetes accordingly.

And finally, those people with type 2 diabetes who have frailty.

So depending on which class these people with type 2 diabetes fall into, we manage or intensify their therapy as we call in diabetes world accordingly.

So regardless of their profiling, you start everybody on modified lees metformin and SGLT2 inhibitor.

How exciting to have a therapy that we know that's approved in type 1 diabetes that we know can mitigate that complication.

And into this bucket, Stacey, I would also put adjunctive therapies like GLP-1 receptor agonists and SGLT inhibitors, where all of the trials have been focused on type 2 diabetes, but we know there are benefits to protect the heart, to protect the kidneys, to protect people with type 1 diabetes for long-term complications.

And we also heard really great results in that space as well.

So again, this is essential for people to live well with type 1 diabetes, that we don't just think all the time about glucose and insulin, that we think about any downstream complications that we can prevent or slow down.

Though in these type 2 diabetes trials, the primary endpoint is A1C, we saw somewhere around 15% weight loss in people with type 2 diabetes, which is very, very robust for that population.

But then reimagined 2 actually looked at people already on anti-hyperglycemic agents, so metformin with or without SGLT2 inhibitor.

And as with the phase 2 study, looked at cagrisema versus semaglutide alone, 2.4 milligrams versus cagrelentide.

And we saw greater reduction in body weight and hemoglobin A1c.

Well, let's first talk about this conundrum.

We're all so excited about SGLT2 inhibitors and using them widely in our patients with CKD.

But there is a particular issue with polycystic kidney disease.

So let's first just talk a little bit about the background and where we currently are prior to this paper being published.

We are all familiar with the evidence basis for SGLT2 inhibitors.

in chronic kidney diseases that are not caused by polycystic kidney disease.

And those come from multiple very well conducted international phase three randomized control trials.

What is known about the biology of how these drugs might work in polycystic kidney disease?

It's about what happens to people in hospital and then what happens to them when they get out of hospital, whether in fact they ever see their GP and the connectivity between hospitals and general practitioners.

So this is a study looking at people with type 2 diabetes who go into hospital And they are on certain drugs, SGLT2 inhibitors.

So they're different from GLP-1s.

They're important drugs.

The analysis is allowed by really terrific data from a group called the Medicines Intelligence Research Program at the University of New South Wales, which in fact, for people who saw my ADHD program, adult ADHD program earlier on in the year, I used them for ADHD prescribing rates.

The person who's done this study into people with type 2 diabetes is Dr. Tamara Milder, who's an endocrinologist and a researcher at the Medicines Intelligence Research Program.

the drug class known as SGLT2 inhibitors.

We have two available.

It appears to have an effect where it pulls glucose into the kidney and basically increases the filtration, the glomerular filtration of glucose.

So it slightly lowers glucose, not as potently as something called an SGLT2 inhibitor, which is a class of drug that does that.

But it's very interesting nonetheless.

So, you know...