Physicians’ Considerations and Practice Recommendations Regarding the Use of Sodium-Glucose Cotransporter-2 Inhibitors

Authors

Serge A. Jabbour, Thomas Jefferson UniversityFollow
Nasrien E. Ibrahim, INOVA Heart and Vascular Institute
Christos P. Argyropoulos, University of New Mexico

Document Type

Article

Publication Date

10-13-2022

Comments

This is the author's final version published in the Journal of Clinical Medicine, Volume 11, Issue 20, October 2022, Article number 6051.

The published version is available online at https://doi.org/10.3390/jcm11206051. Copyright © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Abstract

Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) (canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin), although initially developed as glucose-lowering drugs, provide significant beneficial effects on cardiorenal outcomes, including heart failure, regardless of type 2 diabetes status. Integration of SGLT-2is into clinical practice requires practical guidance for physicians about their use. To overcome physicians’ clinical inertia for SGLT-2i use, including addressing safety, potentially a barrier to their use, a roundtable discussion with physicians from three specialties (cardiology, endocrinology, and nephrology) was conducted. This review summarizes the physicians’ clinical experience and recommendations about SGLT-2i use across different patient populations, taking into consideration the beneficial effects of SGLT-2is and their safety. The key aspects discussed regarding SGLT-2i safety include acute effects on kidney function (estimated glomerular filtration rate acute dip upon SGLT-2i initiation and acute kidney injury), volume depletion, diabetic ketoacidosis, genitourinary infections, hyperkalemia, and hypoglycemia. To mitigate any potential risks related to SGLT-2i safety, physicians can make minor adjustments to an individual patient’s treatment plan, while retaining the SGLT-2i cardiorenal benefits for effective disease management. Recognition by physicians that the benefits of SGLT-2i use on clinical outcomes outweigh the risks will result in the integration of SGLT-2is into clinical practice and lead to improved patient care and outcomes.

Recommended Citation

Jabbour, Serge A.; Ibrahim, Nasrien E.; and Argyropoulos, Christos P., "Physicians’ Considerations and Practice Recommendations Regarding the Use of Sodium-Glucose Cotransporter-2 Inhibitors" (2022). Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers. Paper 7.
https://jdc.jefferson.edu/endocrinologyfp/7

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Language

English