SGLT2 inhibitors in Type 2 Diabetes Melitus (T2DM)


SGLT2 inhibitors are a relatively new class of drug initially licensed for their glucose lowering effects in T2DM. Emerging evidence suggests they provide benefits beyond HbA1C reduction, eg, reducing risk of hospitalisation for heart failure, cardiovascular death, and progression of diabetic nephropathy.

It is unclear at present whether these benefits are a class effect and some agents have licences for specific indications. The following flowchart demonstrates some of the factors to consider when initiating an SGLT2 inhibitor.

Further details regarding prescribing in renal/hepatic impairment can be found in the Achieving control in T2DM guidance.  Consideration should also be given to reducing sulfonylurea or insulin dose if adding in an SGLT2 inhibitor to reduce risk of hypoglycaemia.

Glucose lowering effects are dependent on adequate renal function, therefore SGLT2 inhibitors should not be started for glucose lowering if eGFR is less than 60mL/min.
They can be commenced with an eGFR between 30 to 60mL/min for renoprotection in individuals with proteinuria or in the management of heart failure with reduced ejection fraction, along with ACE inhibitor/ARB, etc. If used for these specific indications then they should be continued if eGFR drops below 45mL/min, unless in the context of acute kidney injury, and can be continued if eGFR drops below 30mL/min.

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Abbreviation Meaning
ACE Angiotensin-converting enzyme
ARB Angiotensin receptor blockers
eGFR Estimated glomerular filtration rate
HbA1C Haemoglobin A1c
SGLT2 Sodium-glucose transport protein 2
T2DM Type 2 Diabetes Mellitus

Last reviewed: 21 February 2022

Next review: 28 February 2025

Author(s): Diabetes MDT

Version: 2

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Consultant Endocrinologist

Document Id: TAM477