Sodium-glucose transport protein 2 (SGLT2) inhibitors are a class of medications used to treat type 2 diabetes. They’re also known as gliflozins.
SGLT2 inhibitors prevent the reabsorption of glucose from blood that’s filtered through your kidneys, therefore facilitating glucose excretion in the urine. This helps to lower your blood sugar levels.
Read on to learn more about the different types of SGLT2 inhibitors, as well as the potential benefits and risks of adding this type of medication to your treatment plan.
To date, the U.S. Food and Drug Administration (FDA) has approved four types of SGLT2 inhibitors to treat type 2 diabetes:
- Invokana (canagliflozin): Invokana can help do the following in adults with type 2 diabetes:
- improve management of blood sugar
- reduce the risk of severe cardiovascular complications in adults with both type 2 diabetes and cardiovascular disease
- lower the risk of kidney disease, cardiovascular death, and hospitalization for heart failure in adults with both type 2 diabetes and diabetic nephropathy
- Farxiga (dapagliflozin): Farxiga is indicated for both type 2 diabetes and heart failure. It can do the following:
- improve management of blood sugar
- reduce the risk of hospitalization for heart failure in adults with both type 2 diabetes and cardiovascular disease
- reduce the risk of cardiovascular death and hospitalization in adults with heart failure with reduced ejection fraction
- reduce the risk of further worsening of kidney disease and slow the progression toward end-stage kidney disease
- Jardiance (empagliflozin): Jardiance can be used to help achieve the following in adults with type 2 diabetes:
- improve management of blood sugar
- reduce the risk of cardiovascular death in adults with both type 2 diabetes and cardiovascular disease
- Steglatro (ertugliflozin): Steglatro can be used in adults with type 2 diabetes to improve management of blood sugar.
If you have type 2 diabetes, it’s possible that you may be prescribed an SGLT2 inhibitor along with another diabetes medication like metformin.
Comparing SGLT2 inhibitors
| SGLT2 inhibitor | FDA approval | Indications | Dose |
| Invokana (canagliflozin) | 2013 | Type 2 diabetes | 100 – 300 mg daily |
| Farxiga (dapagliflozin) | 2014 | Type 2 diabetes Heart failure | Type 2 diabetes: 5 – 10 mg daily Heart failure: 10 mg daily |
| Jardiance (empagliflozin) | 2014 | Type 2 diabetes | 10 – 25 mg daily |
| Steglatro (ertugliflozin) | 2017 | Type 2 diabetes | 5 – 15 mg daily |
SGLT2 inhibitors are generally considered safe. But in some cases, they can cause side effects.
For example, taking this type of medication may raise your risk of developing:
- urinary tract infections (UTIs)
- yeast infections
- diabetic ketoacidosis, which causes your blood to become acidic
- hypoglycemia, or low blood sugar
- hypotension, or low blood pressure
In rare cases, more serious side effects can occur when taking SGLT2 inhibitors:
- A serious type of genital infection has been
reported in people who take SGLT2 inhibitors. This type of infection is known as necrotizing fasciitis or Fournier’s gangrene. - Some research also suggests that Invokana (canagliflozin) might increase the risk of bone fractures. These adverse effects haven’t been linked to other SGLT2 inhibitors.
- In some individuals, it’s possible to experience kidney injury or reduced kidney function when taking SGLT2 inhibitors.
- Although evidence is inconsistent, some
research indicates that Invokana (canagliflozin) was associated with an increased risk of lower limb amputation.
Your doctor can let you know more about the potential risks of taking SGLT2 inhibitors. They can also help you learn how to recognize and manage any possible side effects.
If you think you might be experiencing side effects from medication, contact your doctor right away.
When taken alone or with other diabetes medications, SGLT2 inhibitors can help lower your blood sugar levels. This reduces your chances of developing complications from type 2 diabetes.
According to a 2018 study, SGLT2 inhibitors may also promote weight loss and modest improvements in your blood pressure and blood cholesterol levels.
A 2018 review found that SGLT2 inhibitors were linked to lower risk of stroke, heart attack, and death from cardiovascular disease in people with type 2 diabetes and hardened arteries. It also found that SGLT2 inhibitors may slow the progression of kidney disease.
Keep in mind, the potential benefits of SGLT2 inhibitors vary from one person to another, depending on their medical history. To learn more about this type of medication, and whether it’s a good fit for your treatment plan, talk with your doctor.
SGLT2 inhibitors and heart failure
According to a report in the
They note that several recent studies on cardiovascular outcomes in type 2 diabetes have shown benefits for the use of SGLT2 inhibitors in reducing hospitalizations due to heart failure.
Indeed, the
SGLT2 inhibitors can also be beneficial for people without type 2 diabetes.
A 2019 study found that Farxiga (dapagliflozin) reduced the risk of worsening heart failure or death due to heart failure with reduced ejection fraction (or, how much blood a heart ventricle pumps out with each contraction) in people with and without type 2 diabetes.
The FDA approved Farxiga (dapagliflozin) to treat this type of heart failure in 2020. It’s possible that additional SGLT2 inhibitors may be approved for heart failure in the future, but additional clinical trials are necessary.
SGLT2 inhibitors are oral medications. They’re available in pill form. If your doctor adds an SGLT2 inhibitor to your treatment plan, they’ll typically advise you to take it once a day.
In some cases, your doctor might prescribe an SGLT2 inhibitor along with other diabetes medications. For example, this class of medication may be combined with metformin.
A combination of diabetes medications might help you keep your blood sugar level within target range. It’s important to take the proper dose of each medication to stop your blood sugar level from dropping too low.
Whenever you add a new medication to your treatment plan, it’s important to consider how it might interact with medications you already take.
If you take other diabetes medications to manage your blood sugar levels, adding an SGLT2 inhibitor increases your risk of developing low blood sugar.
In addition, if you’re taking certain types of diuretics, SGLT2 inhibitors can increase their effect, causing you to urinate more often. This can raise your risk of dehydration and low blood pressure.
Before you start taking a new medication or supplement, ask your doctor if it could interact with anything in your existing treatment plan. In some cases, your doctor might make changes to your prescribed treatment to lower your risk of negative drug interactions.
SGLT2 inhibitors are designed to help manage blood sugar in people living with type 2 diabetes.
In addition to reducing blood sugar levels, this class of medication has been found to have benefits for heart failure, other cardiovascular conditions, and kidney disease.
Although they’re generally considered safe, SGLT2 inhibitors sometimes cause side effects or negative interactions with certain drugs. Your doctor can tell you more about the potential benefits and risks of adding this type of medication to your treatment plan.