Canagliflozin is prescribed for a patient with type 2 diabetes and established cardiovascular disease. Beyond glycaemic control, which outcome benefit is most directly linked to its unique mechanism of reducing renal sodium-glucose reabsorption?
- A Reduction of HbA1c to near-normal levels preventing microvascular complications
- B Stimulation of GLP-1 secretion from intestinal L-cells reducing postprandial glucose spikes
- C Reduction of glomerular hyperfiltration and intraglomerular pressure, protecting renal function independently of glucose lowering ✓
- D Reduction of hepatic glucose production by inhibiting glucokinase regulatory protein
Correct answer: C. Reduction of glomerular hyperfiltration and intraglomerular pressure, protecting renal function independently of glucose lowering
Explanation
SGLT2 inhibitors restore tubuloglomerular feedback by delivering more sodium to the macula densa, causing afferent arteriolar constriction and reduction of glomerular hyperfiltration. This mechanism — distinct from glucose lowering — directly reduces intraglomerular pressure, protects podocytes, and slows CKD progression. This was demonstrated in CREDENCE and DAPA-CKD trials even in non-diabetic CKD. SGLT2 inhibitors do not stimulate GLP-1 secretion (that is DPP-4 inhibitors' effect) and do not inhibit hepatic glucose production directly.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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