Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-38

Table 5: Sodium Glucose Co-transporter 2 (SGLT2) Inhibitors (13,74,82-88) SGLT2 inhibitors Therapeutic Considerations

Adverse effects • Increased urination • Genital mycotic infections (3-4 fold) (females > males uncircumcised) • Urinary tract infections (higher in female) • Hypotension, volume depletion • Increase in LDL-C • Rare cases of DKA (<0.1% of treated people), which may occur without hyperglycemia Caution • Renal dysfunction, loop diuretics • Use in the elderly. • Caution required when combined with low carbohydrate eating patterns or with suspected insulin deficiency • Good foot care always recommended – particularly in those with high-risk feet (loss of protective sensation, previous foot ulcer or amputation) • Hold prior to major surgery or during serious illness or infections ** Important to review Sick-Day Management with all people taking SGLT2- inhibitors. Hold during acute illnesses associated with risk for dehydration or procedures associated with high risk of acute kidney injury. Refer to “ Antihyperglycemic agents and sick-day medication list” found later in this chapter.

Benefits: • ↓ A1C levels 0.5 - 0.7% (less

glycemic efficacy at lower GFR)

• Weight loss 2 kg - 3.0 kg • Low risk of hypoglycemia. • ↓ systolic BP of 3 - 5 mmHg and diastolic BP by 2 mmHg

SGLT2 Inhibitors should not be initiated in people with an eGFR ˂ 30 mL/min /1.73m 2 . Small

reduction in eGFR (<20%) expected when initiated.