Cardioprotection with Yet Another SGLT2 Inhibitor — An Embarrassment of Riches

This editorial reviews emerging data on sotagliflozin, a dual inhibitor of sodium-glucose cotransporters 1 and 2 (SGLT1/SGLT2), in cardiovascular risk management for patients with diabetes. Findings from the SOLOIST-WHF and SCORED trials showed that sotagliflozin reduces heart failure–related events and cardiovascular deaths without unexpected adverse effects. Despite initial hopes for use in type 1 diabetes, the elevated risk of diabetic ketoacidosis has limited its role in that population. In type 2 diabetes, however, the cardiovascular and renal benefits appear consistent with those of other SGLT2 inhibitors. The authors note that sotagliflozin's intestinal SGLT1 inhibition did not compromise safety or amplify benefits beyond class effects. They suggest that the abundance of effective agents including five SGLT2 inhibitors and several GLP-1 receptor agonists now constitutes an “embarrassment of riches” in diabetes care, though careful patient-specific risk assessment remains essential. Broader implementation of these therapies could help address the global diabetes burden and reduce morbidity from cardiovascular and kidney disease.

This editorial reviews emerging data on sotagliflozin, a dual inhibitor of sodium-glucose cotransporters 1 and 2 (SGLT1/SGLT2), in cardiovascular risk management for patients with diabetes. Findings from the SOLOIST-WHF and SCORED trials showed that sotagliflozin reduces heart failure–related events and cardiovascular deaths without unexpected adverse effects. Despite initial hopes for use in type 1 diabetes, the elevated risk of diabetic ketoacidosis has limited its role in that population. In type 2 diabetes, however, the cardiovascular and renal benefits appear consistent with those of other SGLT2 inhibitors. The authors note that sotagliflozin's intestinal SGLT1 inhibition did not compromise safety or amplify benefits beyond class effects. They suggest that the abundance of effective agents including five SGLT2 inhibitors and several GLP-1 receptor agonists now constitutes an “embarrassment of riches” in diabetes care, though careful patient-specific risk assessment remains essential. Broader implementation of these therapies could help address the global diabetes burden and reduce morbidity from cardiovascular and kidney disease.