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Sodium-Glucose Cotransporter-2 Inhibitors Across the Glycemic Spectrum: Cardiovascular and Renal Outcomes With

Raghad Abdelfadil Elgazzar1, Mahmoud Ramadan2

  • 1College of Medicine, University of Sharjah, Sharjah, ARE.

Cureus
|April 17, 2026
PubMed

Insights

Sodium-glucose cotransporter 2 (SGLT2) inhibitors offer significant benefits beyond diabetes management. These SGLT2 inhibitors reduce heart failure hospitalizations and slow chronic kidney disease progression in diverse patient groups.

Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology

Background:

  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors were developed for type 2 diabetes mellitus (T2DM).
  • Trials revealed benefits beyond glycemic control, including reduced heart failure (HF) and slowed chronic kidney disease (CKD) progression.

Purpose of the Study:

  • To review current evidence on SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin, ertugliflozin) for cardiovascular and renal outcomes.
  • To synthesize findings from recent studies (2019-2025) across various patient populations.

Main Methods:

  • Narrative literature review of PubMed and Google Scholar.
  • Inclusion of randomized controlled trials, observational studies, meta-analyses, guidelines, and mechanistic studies.
  • Focus on studies published between January 2019 and December 2025.

Main Results:

  • Mechanistic data suggest benefits via natriuresis, osmotic diuresis, improved cardiac energetics, and reduced inflammation.
  • SGLT2 inhibitors consistently reduce HF hospitalizations and cardiorenal endpoints in diabetic and non-diabetic patients across CKD stages.
  • A generally favorable safety profile exists, with genital mycotic infections being most common.

Conclusions:

  • SGLT2 inhibitors demonstrate significant cardiorenal protective effects.
  • Current data support their use as foundational therapy for heart failure and/or CKD, regardless of diabetes status.
  • Further research is needed for stage 5 CKD, dialysis populations, and specific post-MI cohorts.
Keywords:
canagliflozincardiovascular outcomeschronic kidney diseasedapagliflozinempagliflozinheart failurenatriuresisrenal outcomessglt2 inhibitorstype 2 diabetes mellitus

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