SGLT2 inhibitors are a class of drugs that can offer significant benefits for managing kidney disease, type 2 diabetes, and cardiovascular health. Here, registered dietitian Michele Crosmer, RN, CSR and Dr. Sean Hashmi, MD, MS, FASN discuss how SGLT2 inhibitors work, their advantages and potential side effects, and considerations for specific patient populations.*

How SGLT2 Inhibitors Work and Who Should Avoid Them

SGLT2 inhibitors, or sodium-glucose co-transporters, prevent glucose from being reabsorbed in the kidneys, leading to more sugar being excreted in the urine, Dr. Hashmi explains. This class of drugs can be recognized by their names, ending in “-gliflozin,” such as empagliflozin and dapagliflozin. 

The medications are not beneficial or safe for everyone, however. According to Hashmi, people who should avoid taking these medications include those:

• With type 1 diabetes, due to the risk of diabetic ketoacidosis (DKA)
• With low bone mineral density, due to associations between low bone density and adverse effects such as bone fractures
• Prone to recurrent infections, such as urinary tract infections (UTIs) or yeast infections 

“If you’re somebody who’s had a lot of urine infections,” Hashmi says, “…you definitely do not want to take this.” 

Benefits of SGLT2 Inhibitors

For those who can safely take them, evidence indicates that SGLT2 inhibitors may have multiple health benefits beyond managing blood sugar levels. According to Hashmi, they can:

• Improve cardiovascular health. Studies have shown a reduction in cardiovascular mortality in Type 2 diabetics who use SGLT2 inhibitors.
• Help with heart failure. Patients with heart failure see improvements in symptoms and a reduced risk of hospitalization when on these medications.
• Protect kidney function. For patients with or without diabetes, SGLT2 inhibitors help slow the progression of kidney disease.

One of the most striking findings, he says, is that “you can lower [all-cause mortality in kidney disease patients] by about 14% simply by putting patients on an SGLT2.”

Potential Side Effects and Usage Guidelines

Despite their benefits, SGLT2 inhibitors come with some significant risks, such as:

• Increased infections. Up to 10% of patients in some studies experienced UTIs or yeast infections.
• Risk of dehydration and hypotension. Since these drugs act as diuretics, you may experience dehydration or low blood pressure.
• Risk of acute kidney injury. Your doctor will likely monitor your kidney function through regular tests when you start taking these medications.

There is also a rare, but real, risk of amputation in some patients, Hashmi cautions, though the exact cause remains unclear.

Takeaway

SGLT2 inhibitors can offer substantial benefits for patients with diabetes, heart failure, and kidney disease, but they are not without risks. These medications should be used under careful medical supervision, Hashmi says, particularly for people with complex health profiles. Starting treatment early is key to maximizing benefits and minimizing complications.

*Plant Based Kidney Health. (2023, January 2). What are SGLT2 Inhibitors and how do they affect kidney disease? [Video file]. Retrieved from https://www.youtube.com/watch?v=USX6LkXJbfU 

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