Bob,
I'm in the camp that does not see much usefullness of this drug. T2 is characterized by decreased insulin production, increased insulin resistance or both. The net result being hyperglycemia which has devastating effects on all organ systems. Canagliflozin attemps to reduce the hyperglycemia, but does not address the root problem. I doubt Canagliflozin would be used as monotherapy but rather as an add on with other drugs that either stimulate the pancreas or increase insulin sensitivity. It might allow lower dosages of current medications to be used.
I have long said that the problem is getting insulin in sufficient quantity to receptors on the cells. Thus exogenous insulin should be the 1st choice, not the last.
Your question about fatty acid metabolism, and this would also apply to burning proteins for fuel as well (very "dirty" process and hard on the kidneys) is a good one. I think the Canagliflozin might have some effect, but maybe not a major one, since you are not totally depriving the cells of glucose. I do think we should attempt to return a diabetic's metabolic physiology to as normal a state as possible - thus insulin.
