Sodium-glucose cotransporter 2 inhibitors

While I’ve been hard on newer medications like SGLT2i for their relatively small benefit in lower-risk patients, recent systematic reviews show that our traditional interventions are no better, and may be worse, at reducing risks of outcomes. I now discuss the option of adding an SGLT2i with patients with diabetes and pre-existing cardiovascular or renal disease or with symptomatic hyperglycemia where blood glucose reduction would be expected to reduce day-to-day symptoms. I reduce or discontinue doses of other antihyperglycemic medications if possible when starting an SGLT2i and I educate patients about potential adverse events.