Selective Sodium-Glucose Transporter 2 (SGLT2) Inhibitors

Selective sodium-glucose transporter 2 (SGLT2) inhibitors are a class of drugs approved to treat type 2 diabetes (T2D). They lower blood sugar (glucose) levels by increasing the amount of glucose in your urine. Four SGLT2 inhibitors are approved to treat people with T2D.

SGLT2 inhibitors are not the first treatment option for T2D. If diet, exercise, and other drugs are not effective, your doctor may suggest trying SGLT2 inhibitors. Talk to your doctor about your specific benefits and risks of SGLT2 inhibitors.

How do SGLT2 inhibitors work?

Our kidneys help filter glucose and absorb it back into the body. One protein called "sodium-glucose transporter 2" (SGLT2) mainly performs this function. Normally, this absorption stops at a certain blood glucose level. Above that level, our bodies get rid of glucose through our urine (glucosuria).1,2

But for people with diabetes, absorption stops at a much higher blood glucose level. This can lead to high blood sugar levels for people with T2D.1

Drugs that block SGLT2 reduce the absorption of glucose back into your body. This promotes the excretion of glucose in your urine. They can slightly lower blood sugar levels for people with T2D.1,3

SGLT2 inhibitors have other effects that help treat T2D, such as:1

  • Improved levels of albumin in urine (albuminuria)
  • Modest weight loss
  • Lower blood pressure
  • Improved oxygen delivery

Examples of SGLT2 inhibitors

Four SGLT2 inhibitors are currently approved to treat people with T2D. These include:2

  • Invokana® (canagliflozin)
  • Jardiance® (empagliflozin)
  • Farxiga® (dapaglifliozin)
  • Steglatro® (ertuglifliozin)

The choice of which SGLT2 inhibitor you take depends on factors that are personal to you. Some of these factors are:2

  • Whether you have other medical conditions, such as heart or kidney disease
  • Cost and insurance coverage
  • Personal preference

What are some possible side effects of SGLT2 inhibitors?

Side effects can vary depending on the specific SGLT2 inhibitor you take. SGLT2 inhibitors have a low risk of causing low blood sugar (hypoglycemia). This risk increases when you take other drugs that cause hypoglycemia.1,2
The most common side effects of SGLT2 inhibitors include:1,2

  • Increased urination
  • Dehydration
  • Genital yeast infections
  • Urinary tract infections

More serious side effects are rare but possible. These include:1,2

  • High levels of ketones in the blood or urine (ketoacidosis)
  • Kidney problems
  • High levels of potassium in the blood
  • Serious urinary tract infections
  • Bone fractures
  • The need to amputate, usually a toe or part of a foot

These are not all the possible side effects of SGLT2 inhibitors. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you after you begin taking SGLT2 inhibitors.

Other things to know about SGLT2 inhibitors

SGLT2 inhibitors are not the first treatment option for people with T2D. Diet, exercise, and metformin or other drugs are usually used first. SGLT2 inhibitors also may be more expensive and less effective in the long term than other drugs.2

Your doctor may suggest you take an SGLT2 inhibitor in the following situations:2

  • When lifestyle changes are not enough to manage blood sugar
  • When other drugs are not enough to control blood sugar
  • If you have other medical conditions, such as heart disease

Take SGLT2 inhibitors exactly as your doctor prescribes. They are usually taken once a day by mouth. Certain types must be taken in the morning before having food. Other types can be taken any time of day with or without food.2

Your doctor may perform kidney function tests before and during treatment. Before taking SGLT2 inhibitors, tell your doctor if you:2

  • Have any other medical conditions, especially:
    • Kidney problems
    • Diabetic ketoacidosis
  • Often have urinary tract infections or yeast infections
  • Have low bone density or a high risk for fractures
  • Are allergic to any drug ingredients
  • Take any other drugs, including:
    • Vitamins
    • Supplements
    • Over-the-counter drugs

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Written by: Matt Zajac | Last reviewed: May 2022