SGLT2 inhibitors are an important class of medicines used in type 2 diabetes. Their role extends beyond glucose lowering: in appropriate patients, they can reduce the risk of heart failure and slow progression of chronic kidney disease.
How Do SGLT2 Inhibitors Work?
These medicines reduce glucose and sodium reabsorption in the kidney, increasing urinary glucose excretion. They also produce effects on blood pressure, intraglomerular pressure and fluid balance.
Who May Benefit?
ADA 2026 recommends SGLT2 inhibitors with demonstrated benefit for appropriate people with type 2 diabetes and chronic kidney disease, heart failure, or established or high cardiovascular risk. The choice depends on kidney function, comorbidities, adverse-effect risk and individual preferences.
Important Side Effects
- Genital fungal infections can occur.
- Volume depletion and low blood pressure may occur, particularly during illness or poor fluid intake.
- Rarely, diabetic ketoacidosis can occur, sometimes with only modest glucose elevation.
Sick-Day and Surgery Safety
People taking an SGLT2 inhibitor should understand when temporary interruption may be necessary. ADA 2026 advises discontinuation before scheduled surgery and emphasizes sick-day planning and awareness of ketoacidosis symptoms. Prolonged fasting, critical illness and insulin deficiency increase risk.
Do Not Start or Stop It Without Medical Review
The right medicine depends on kidney function, blood pressure, hydration status, concurrent medicines and the person’s cardiovascular and kidney profile. SGLT2 inhibitors are not simply “sugar tablets”; their benefits and risks need individualized assessment.
Related Diabetes Care
Good diabetes treatment also includes nutrition, physical activity, weight management and complication screening. You can read our Diabetes Management With Minimal Medicine article.
References
- ADA Standards of Care in Diabetes—2026: Pharmacologic Approaches to Glycemic Treatment.
- ADA Standards of Care in Diabetes—2026: Cardiovascular Disease and Risk Management.
Dr. Moxit Shah, DM Endocrinology
Vishuddha Endocrine Clinic, Ahmedabad
Phone: +91 99799 92797
