To address common concerns regarding sodium-glucose cotransporter 2 (SGLT2) inhibitor use for patients with type 2 diabetes mellitus (T2DM) in cardiovascular practice.
SGLT2 inhibitors provide glycemic control and improve cardiovascular and renal endpoints in T2DM. Cardiovascular outcome trials have demonstrated sustained cardiovascular, heart failure and renal benefits independent of glycemic control, which persist down to an eGFR of 30 ml/min/1.73 m2. SGLT2 inhibitors can be safely administered alongside common diuretics, and routine monitoring of renal function is advised at initiation of therapy, particularly for patients on loop diuretics. Mild initial reductions in eGFR are expected, usually stabilizing over time. The most common adverse effect noted with SGLT2 inhibitors is genital mycotic infections, primarily in women. Less common, but concerning effects associated with canagliflozin include increased risk of fractures and lower limb amputations, particularly in patients with previous amputation history. Overall, SGLT2 inhibitors are well tolerated and effective adjuncts to diabetic treatment, for which the benefits seem to outweigh the risks.
The care of patients with T2DM requires an interdisciplinary team approach, within which the role of cardiologists is expanding. SGLT2 inhibitors are an encouraging treatment option for achieving glycemic control, whilst also improving cardiovascular and renal outcomes.
aInstitute of Medical Science, University of Toronto
bFaculty of Medicine, University of Toronto
cDivision of Cardiac Surgery, St. Michael's Hospital, Toronto
dLMC Diabetes & Endocrinology, Brampton
eLeadership Sinai Centre for Diabetes, Toronto, Canada
Correspondence to Harpreet S. Bajaj, MD, MPH, ECNU, FACE, LMC Diabetes & Endocrinology, 2130 North Park Drive, Suite 238, Brampton, ON L6S 0C9, Canada. Tel: +1 905 595 0560; fax: +1 905 595 0562; e-mail: email@example.com