Public Health and Primary CareReview Article

SGLT2 inhibitors: a narrative review of efficacy and safety

Donald S. Nelinson, PhD; Jose M. Sosa, MD; and Robert J. Chilton, DO
Notes and Affiliations
Notes and Affiliations

Received: June 15, 2020

Accepted: September 3, 2020

Published: February 11, 2021

  • Donald S. Nelinson, PhD, 

    American College of Osteopathic Internists, Rockville, MD 20852, USA

  • Jose M. Sosa, MD, 

    Department of Medicine, Division of Cardiology, Brooke Army Medical Center San Antonio, TX 78234, USA

  • Robert J. Chilton, DO, 

    Professor of Medicine, Department of Medicine, Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78284, USA

J Osteopath Med; 1(2): 229-239

Type 2 diabetes mellitus (T2DM) is a cardio-renal-metabolic condition that is frequently associated with multiple comorbidities, including atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD). The sodium-glucose co-transporter-2 (SGLT2) inhibitors, which lower glycated hemoglobin, fasting and postprandial plasma glucose levels, body weight, and blood pressure, as well as reduce the risk of a range of cardiovascular and renal outcomes without increasing hypoglycaemic risk, have heralded a paradigm shift in the management of T2DM. These drugs are compatible with most other glucose-lowering agents and can be used in patients with a wide range of comorbid conditions, including ASCVD, HF, and CKD, and in those with estimated glomerular filtration rates as low as 30 mL/min/1.73 m2. However, there are misunderstandings surrounding the clinical implications of SGLT2 inhibitors’ mechanism of action and concerns about the key adverse events with which this class of drugs has been associated. This narrative review summarizes the data that support the efficacy of SGLT2 inhibitors in reducing the risks of cardiovascular and renal outcomes in patients with T2DM and comorbid conditions and clarifies information relating to SGLT2 inhibitor-related adverse events.

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