References

SGLT-2 inhibitors associated euglycemic and hyperglycemic DKA in a multicentric cohort. 2021. 10.1038/s41598-021-89752-w

Cusi K, Isaacs S, Barb D American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022; 28:(5)528-562 https://doi.org/10.1016/j.eprac.2022.03.010

KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022; 102:(5S)S1-S127 https://doi.org/10.1016/j.kint.2022.06.008

Mendes A Recognising and treating diabetic ketoacidosis. J Presc Pract. 2025; 7:(2)56-58 https://doi.org/10.12968/jprp.2025.0023

Monzo L, Ferrari I, Cicogna F, Tota C, Calò L Sodium-glucose co-transporter-2 inhibitors eligibility in patients with heart failure with reduced ejection fraction. Int J Cardiol. 2021; 341:56-59 https://doi.org/10.1016/j.ijcard.2021.08.035

Pabel S, Hamdani N, Singh J, Sossalla S Potential mechanisms of SGLT2 inhibitors for the treatment of heart failure with preserved ejection fraction. Front Physiol. 2021; 12 https://doi.org/10.3389/fphys.2021.752370

Pereira MJ, Eriksson JW Emerging role of SGLT-2 inhibitors for the treatment of obesity. 2019; 79:(3)219-230 https://doi.org/10.1007/s40265-019-1057-0

Thain A, Webster C Pharmacodynamics in paramedic practice. J Paramed Pract. 2025; 17:(2)54-58 https://doi.org/10.12968/jpar.2024.0120

Zelniker TA, Wiviott SD, Raz I, Im K, Goodrich EL, Bonaca MP, Mosenzon O, Kato ET, Cahn A, Furtado RHM, Bhatt DL, Leiter LA, McGuire DK, Wilding JPH, Sabatine MS SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019; 393:(10166)31-39 https://doi.org/10.1016/S0140-6736(18)32590-X

Diabetes

Optimising the prescribing of SGLT2 inhibitors

02 May 2025
News Analysis
ketone test strips

Abstract

Aysha Mendes looks at the use of SGLT-2 inhibitors, and considers how they can be continued effectively to benefit patients while minimising risks

In the February issue, we explored the assessment and management of diabetic ketoacidosis (DKA) (Mendes, 2025). DKA is a known complication previously of type 1 diabetes, but now more commonly seen in type 2 diabetes as well (Mendes, 2025). A primary reason for this spike in DKA cases among individuals living with type 2 diabetes is an increase in the prescription of sodium-glucose co-transporter-2 (SGLT-2) inhibitors (which are contraindicated in people with type 1 diabetes owing to their increased risk of developing DKA (Mendes, 2025).

The cause of DKA in patients taking SGLT2 inhibitors is unclear but possible theories surround the increased incidence of dehydration and infections (Ata et al, 2021).

SGLT-2 inhibitors are antihyperglycemic transporting agents that act upon the SGLT-2 proteins expressed in the proximal convoluted tubules in the nephron to pump filtered glucose from the kidneys back into the blood (Padda et al, 2023; Thain and Webster, 2025). As a result of this action, the amount of sodium and glucose absorbed by the blood is reduced, and excretion through the urine is encouraged (Kirwin and Cannon, 2025). This makes SGLT-2 inhibitors an effective treatment for choice for the management of type 2 diabetes, despite the increased risk of DKA (Mendes, 2025).

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