SGLT2Hemmer

SGLT2-Hemmer (SGLT2 inhibitors) are a class of antidiabetic medications used to treat type 2 diabetes. They work by inhibiting the sodium-glucose cotransporter 2 in the proximal renal tubules, reducing glucose reabsorption and increasing urinary glucose excretion. This glucose loss lowers plasma glucose and HbA1c, and the drugs also provide a mild diuretic effect and modest reductions in blood pressure.

Agents in this class include canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. They are approved for glycemic control in type 2 diabetes and, in several cases, have indications for heart failure or chronic kidney disease independent of diabetes status.

Beyond glucose lowering, SGLT2 inhibitors have demonstrated cardiovascular and renal benefits in large outcome trials, such as reduced hospitalization for heart failure and slowed progression of CKD. These findings have influenced guideline recommendations for patients with heart failure with reduced ejection fraction and chronic kidney disease, in addition to those with type 2 diabetes.

Common adverse effects include genital yeast infections and urinary tract infections due to glycosuria, along with volume depletion and blood pressure reduction. Rare but serious risks include euglycemic ketoacidosis and, very rarely, Fournier gangrene. Efficacy wanes with advanced renal impairment, and dosing is often adjusted for kidney function. They may increase the risk of hypoglycemia when combined with insulin or insulin secretagogues; monitoring renal function, electrolytes, hydration, and signs of infection is advised.