Safety and Tolerability of SGLT2 Inhibitors

Area of Science:

• Pharmacology
• Cardiology
• Nephrology

Background:

• Sodium-glucose co-transporter (SGLT) inhibitors have transformed cardiorenometabolic therapy.
• These agents, including selective SGLT2 and dual SGLT1/2 inhibitors, demonstrate significant benefits in reducing cardiovascular events, heart failure hospitalizations, and kidney disease progression.
• Despite proven efficacy, concerns regarding adverse effects can limit uptake in certain patient groups.

Purpose of the Study:

• To provide an evidence-based framework for anticipating, recognizing, and mitigating complications associated with SGLT inhibitors.
• To address the heterogeneous clinical relevance of traditionally reported risks.
• To support the safe and effective integration of SGLT inhibitors across diverse patient populations.

Main Methods:

• Analysis of large cardiovascular and renal outcome trials.
• Inclusion of real-world evidence to estimate absolute and relative risks.
• Synthesis of data to create a practical management framework.

Main Results:

• SGLT inhibitors markedly reduce cardiovascular events, heart failure hospitalizations, and kidney disease progression in patients with and without diabetes.
• Reported risks (e.g., hypoglycemia, ketoacidosis, infections, fractures) vary in clinical significance and are influenced by patient factors and treatments.
• A nuanced understanding of risks and benefits is crucial for optimal patient care.

Conclusions:

• SGLT inhibitors are highly effective cardiorenometabolic therapies with a generally favorable risk-benefit profile.
• Careful patient selection and monitoring are essential to mitigate potential adverse effects.
• This evidence-based framework aids clinicians in safely utilizing SGLT inhibitors in broad patient populations.