SGLT2 inhibitors
also: gliflozin · dapagliflozin · empagliflozin · flozin
Overview
"-flozin" drugs — now key add-ons in T2DM, and independently prognostic in heart failure and CKD (regardless of diabetes).
Mechanism
Inhibit sodium-glucose cotransporter-2 in the proximal tubule → block glucose reabsorption → glycosuria (and natriuresis) → lower glucose, weight and BP, with cardiorenal protection partly independent of glucose lowering.
Indications
- Type 2 diabetes (esp. with CVD/heart failure/CKD)
- Heart failure (HFrEF and HFpEF) — even without diabetes
- Chronic kidney disease (renoprotective)
The agents
OD
HF + CKD licences.
OD
Strong CV outcome data.
Adverse effects
Glycosuria; counsel hygiene.
DKA with near-normal glucose — stop during acute illness/surgery ("sick-day rule"); high index of suspicion.
Cautions & contraindications
Euglycaemic DKA + volume depletion.
Interactions
- Diuretics → additive volume depletion
Monitoring & kinetics
Renal function, volume status, ketone awareness during illness
Oral OD. Initial small reversible eGFR dip is expected (like ACEi).
Source: NICE NG28 — T2DM · BNF — SGLT2 inhibitors