A GP guide to SGLT2 inhibitors in type 2 diabetes

The benefits and adverse effects of this new class of medications

Need to know:

  • Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are a new drug class for the treatment of type 2 diabetes that inhibit reabsorption of glucose in the renal proximal tubule to promote glycosuria and improve blood glucose levels.
  • SGLT2i offer renoprotective benefits when added to renin–angiotensin system blockade therapy in patients with type 2 diabetes.
  • Empagliflozin, canagliflozin, dapagliflozin and ertugliflozin are approved for use in patients with type 2 diabetes and an eGFR greater than 45mL/min/1.73m2. These cut-offs are based on glycaemic efficacy, and it is likely that the renoprotective properties extend to lower eGFR levels.
  • Prescribers must be vigilant to the risk of SGLT2i-associated diabetic ketoacidosis (DKA), a significant adverse event that often occurs in the context of precipitating factors and may present with euglycaemia.