SGLT2 इनहिबिटर के हो?
SGLT2 inhibitors are a newer class of oral medications for type 2 diabetes, including empagliflozin, dapagliflozin, and canagliflozin. Unlike older diabetes drugs, they were found — somewhat unexpectedly — to provide major heart and kidney benefits independent of their blood-sugar-lowering effect, which has reshaped how they are used in modern diabetes and heart failure care.
SGLT2 (sodium-glucose cotransporter 2) is a protein in the kidney’s proximal tubule that normally reabsorbs most of the glucose your kidneys filter from the blood, sending it back into circulation so it isn’t lost in urine. SGLT2 inhibitors block this transporter, so a significant amount of glucose stays in the urine instead of being reabsorbed, and is excreted from the body. This lowers blood sugar without depending on insulin at all, which is why SGLT2 inhibitors keep working even in people whose beta cells are severely impaired. The same mechanism also causes mild sodium loss and a diuretic-like effect, which is part of how this class protects the heart and kidneys.
In addition to lowering blood sugar, SGLT2 inhibitors provide cardiovascular benefits that are considered one of the most important advances in diabetes care in the past decade. The landmark EMPA-REG OUTCOME trial (2015) found that in people with type 2 diabetes and established cardiovascular disease, empagliflozin reduced cardiovascular death by 38% and hospitalization for heart failure by 35%, compared with placebo — benefits that appeared quickly and were too large to be explained by blood sugar control alone. This cardiovascular benefit is now considered a class effect, and SGLT2 inhibitors are recommended for people with heart failure regardless of whether they have diabetes. The EMPULSE trial (2022) extended this further, showing that starting empagliflozin in patients hospitalized for acute heart failure — whether or not they had diabetes — improved clinical outcomes and quality of life within just 90 days. SGLT2 inhibitors are also protective against kidney disease progression in people with diabetes and chronic kidney disease.
Because SGLT2 inhibitors work by increasing glucose in the urine, they create a sugar-rich environment in the genital area that favors the growth of yeast (most often Candida albicans) and, less commonly, bacteria. This is why genital yeast infections are the most common side effect, occurring in roughly 8 to 10% of people taking these drugs, compared with 3 to 5% on placebo — about two to three times more common. Urinary tract infections can also occur, for the same underlying reason. Good genital hygiene and prompt treatment of any infection symptoms usually resolve this without needing to stop the medication.
SGLT2 inhibitors also have a mild diuretic (fluid-shedding) effect, since blocking glucose reabsorption in the kidney also causes some sodium and water to be lost in the urine alongside it. This can lead to volume depletion — symptoms such as dizziness, especially on standing, or low blood pressure — particularly in older adults, people already taking diuretics, or those who become dehydrated from illness, heat, or reduced fluid intake. This same effect can cause a small, usually temporary rise in creatinine (a marker of kidney function) shortly after starting the drug, which typically stabilizes and is not usually a reason to stop treatment on its own.
A rare but serious side effect is euglycemic diabetic ketoacidosis (DKA) — a form of DKA where blood sugar is only mildly elevated or even normal, which can delay recognition. This happens because SGLT2 inhibitors lower blood glucose independently of insulin, which can mask the usual high-glucose warning sign of DKA even while the underlying process — the body switching to burning fat and producing ketones due to relative insulin deficiency — is still occurring, worsened by glucose loss in the urine and increased glucagon. This risk rises during illness, surgery, prolonged fasting, very low-carbohydrate diets, or dehydration, so many doctors recommend temporarily stopping SGLT2 inhibitors before scheduled surgery and during significant illness ("sick day rules"). Anyone on an SGLT2 inhibitor who develops nausea, vomiting, abdominal pain, or unusual fatigue should seek medical attention and have ketones checked even if their blood sugar reading looks normal.
SGLT2 inhibitors alone rarely cause hypoglycemia, since their glucose-lowering effect does not depend on insulin. However, when combined with insulin or a sulfonylurea — both of which can independently cause low blood sugar — the combined effect increases hypoglycemia risk, and a dose reduction of the insulin or sulfonylurea is often needed when starting an SGLT2 inhibitor.
SGLT2 inhibitors are generally not started in people with significantly reduced kidney function, since their glucose-lowering effect weakens as eGFR falls below 45 mL/min/1.73m², though current guidelines support continuing (or, in some cases, starting) certain SGLT2 inhibitors at lower eGFR levels specifically for their heart and kidney protective effects, separate from blood sugar control — this decision should always be made with your doctor. Anyone with a history of recurrent genital yeast infections, or with urogenital anatomical abnormalities that increase infection risk, should discuss this with their doctor before starting. The medication should be temporarily stopped before major surgery and during serious illness to reduce the risk of euglycemic DKA, and it is not recommended for people with type 1 diabetes or a history of DKA, given the same risk. Older adults and people on diuretics should be monitored for signs of volume depletion, especially in hot weather or during illness with reduced fluid intake.
Before starting an SGLT2 inhibitor, your doctor should check your kidney function (eGFR and creatinine), since this determines whether the drug is appropriate and at what dose, and provides a baseline for later comparison. Blood pressure and volume status should also be assessed beforehand, particularly if you are already on a diuretic. After starting, kidney function is typically rechecked within a few weeks, since a small initial rise in creatinine is expected and needs to be distinguished from a more concerning decline. During treatment, be alert for and report any symptoms of genital or urinary infection, dizziness or lightheadedness (which may indicate volume depletion), or nausea, vomiting, and unusual fatigue (which may indicate euglycemic DKA and should prompt urgent ketone testing even with normal blood sugar). Routine HbA1c monitoring continues as with any diabetes medication, typically every 3 to 6 months.
1. Zinman B, Wanner C, Lachin JM, et al.; EMPA-REG OUTCOME Investigators. "Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes." N Engl J Med. 2015;373:2117–2128. DOI: 10.1056/NEJMoa1504720
2. Voors AA, Angermann CE, Teerlink JR, et al. "The SGLT2 Inhibitor Empagliflozin in Patients Hospitalized for Acute Heart Failure: A Multinational Randomized Trial (EMPULSE)." Nature Medicine. 2022;28(3):568–574. DOI: 10.1038/s41591-021-01659-1
3. American Diabetes Association. "9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026." Diabetes Care. pmc.ncbi.nlm.nih.gov/articles/PMC12690185/
4. American Diabetes Association. "11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026." Diabetes Care, 2026;49(Suppl. 1):S246. diabetesjournals.org/care/article/49/Supplement_1/S246/163914
5. "Sodium-Glucose Transport 2 (SGLT2) Inhibitors." StatPearls [Internet]. NCBI Bookshelf, NBK576405. ncbi.nlm.nih.gov/books/NBK576405
This article has been published by the Healthnep editorial team for general information and educational purposes only. The author is not a licensed medical doctor or professional healthcare practitioner. The content provided here does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified health provider regarding any medical condition or before starting any new treatment. Never disregard professional medical advice or delay seeking it because of something you have read on this platform.
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