Synopsis
Use SGLT2 inhibitors for appropriate glycaemic, heart and kidney benefit while preventing euglycaemic ketoacidosis, dehydration, genital infection and perioperative harm.
- SGLT2 inhibitors cause urinary glucose and sodium loss, with benefits in type 2 diabetes, heart failure and chronic kidney disease that extend beyond HbA1c reduction.
- The glucose-lowering effect diminishes as eGFR falls, but kidney and heart-failure protection can persist within licensed and NICE-recommended renal ranges.
- NICE's February 2026 type 2 algorithm places cardiorenal comorbidity and risk at the centre of selection; check exact product eligibility rather than treating the class as interchangeable.
Key red flags
Nausea, vomiting, abdominal pain, tachypnoea, drowsiness or ketone odour with only modest glucose is a time-critical SGLT2 complication, especially during fasting, illness or insulin reduction.
Investigation priorities
Confirm kidney indication, product eligibility and baseline risk.
Management branches
Type 2 diabetes, heart failure or CKD meets current NICE and licensed criteria.
- Confirm product-specific indication, eGFR, albuminuria, blood pressure, volume status, diabetes type, ketone risk, foot disease, genital infection history and pregnancy status.
- Reconcile diuretics, insulin and sulfonylureas, correcting volume depletion and avoiding abrupt insulin reduction; explain that kidney and heart benefit can exceed the glucose effect.
Key medicines
SGLT2 inhibitorUse the licensed product and dose for the exact diabetes, heart or kidney indication.
Insulin co-therapyRetain essential basal insulin and adjust other doses cautiously from glucose data.