Understanding SGLT2 Drugs for Type 2 Diabetes

By Temma Ehrenfeld and Sherry Baker @temmaehrenfeld
November 22, 2022
Understanding SGLT2 Drugs for Type 2 Diabetes

Type 2 diabetes medications called SGLT2 inhibitors have been around for several decades — and they are now known to help weight control and lower blood sugar.

Most diabetes drugs target insulin levels by increasing the body’s sensitivity to insulin or stimulating more insulin secretion. Sodium-glucose cotransporter-2 medications — better known as SGLT2 inhibitors —work a bit differently. They target the kidneys.

Since the drugs hit the market over a decade ago, they’ve proven to be game changers in the treatment of type 2 diabetes, especially for those who are significantly overweight.


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SGLT2 inhibitors — which include canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) — lower blood sugar by causing the kidneys to remove sugar from the body through urine. The most common approach is to take one of these drugs combined with the best-known diabetes medication, metformin (Glucophage).

Side effects of SGLT2 inhibitors

Be alert for signs of acute kidney injury, marked usually by ketoacidosis, which can put you in the emergency room, the Food and Drug Administration (FDA) reports. Ketones are a chemical byproduct when the body is forced to break down fat for energy because it lacks the insulin needed to use glucose, the normal energy source. Ketoacidosis is rare in type 2 diabetics but has occurred in some people taking SGLT2 inhibitors — even when their blood sugar levels weren’t too high.

Breathing problems, nausea, vomiting, abdominal pain, confusion, and unusual fatigue and sleepiness are all danger signs — sometimes triggered by an illness, not drinking or eating sufficiently, or taking less insulin than usual.

If you suspect ketoacidosis, keep taking your medication but seek immediate medical help, the FDA advises.

Patients with moderate kidney disease may not tolerate SGLT2 drugs, and they’re not recommended for people with more severe kidney trouble. Pregnant women, children, and peoplel with type 1 diabetes, should also stay away from SGLT2 inhibitors.

A modest increase, of about 5 percent, in levels of LDL (“bad”) cholesterol sometimes occurs in people taking the drugs. They can increase the risk of yeast infections, too.

Since SGLT2 medications became widely prescribed for people with type 2  diabetes, the FDA reports other uncommon  — but potentially serious — side effects have been noted. These include loss of bone density, increased risk of urinary tract infections, and increased risk of foot or leg amputation.

Fournier’s gangrene, an extremely rare but life-threatening bacterial infection of the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels in the genital area, has also been linked to SGLT2 drugs.

These may sound like frightening reasons not to take these drugs but, in fact, the side effects are very rare. You can almost always avoid serious problems if you see your healthcare provider for regular check-ups and report any unusual or new symptoms to your doctor while taking SGLT2 inhibitors, or any other prescription medication.

SGLT2 inhibitors and weight loss

Since SGLT2 inhibitors were first studied, they’ve been linked to weight loss. While weight loss isn’t immediately dramatic, it appears to be especially helpful for people who are significantly overweight and likely explains why the drugs are often found to help lower blood pressure in people with hypertension.

What’s more, obese patients may be able to cut back on their other medications if they add a SGLT2 drug to their treatment, according to a study by the American Diabetes Association. Research published in The Lancet found SGLT2s can not only result in significant weight loss over time but also may help people who have heart failure avoid hospitalization.

If you have type 2 diabetes, it’s important to follow your doctor’s medical advice. In addition to taking any medications as prescribed, commit to getting enough exercise, lose weight if needed, and stick to a healthy diet.


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November 22, 2022

Reviewed By:  

Christopher Nystuen, MD, MBA and Janet O'Dell, RN