SGLT2 inhibitors reduce the blood sugar level by increasing urinary glucose excretion. They also help prevent the cardiac and kidney diseases related to diabetes.
SGLT2 inhibitors stop the return of glucose and sodium from the kidneys to blood circulation. This increases the urinary excretion of glucose and sodium. The blood sugar level and often also blood pressure are reduced. SGLT2 inhibitors are also called gliflozins.
SGLT2 inhibitors are used to treat type 2 diabetes in adults as a phase two pharmaceutical product together with metformin or other blood sugar-lowering medicines or insulin therapy. They can also be used on their own, if metformin is not suitable.
In Finland (1/2024), there are four SGLT2 inhibitors in use: dapagliflozin, empagliflozin, ertugliflozin and canagliflozin.
SGLT2 inhibitors stop the operation of the sodium-glucose co-transporter-2 (SGLT2) in the kidneys.
The glomeruli of a healthy adult filter approximately 180 g of glucose daily but, normally, it is absorbed back into the blood. SGLT2 inhibitors prevent this absorption back into blood, increasing the excretion of glucose to urine. The urine glucose level and quantity of urine increase, while the blood sugar level and often also blood pressure drop. Losing glucose into urine also results in a weight loss of a few kg.
SGLT2 inhibitors help prevent cardiac diseases and the kidney disease related to diabetes.
The medicinal product is taken once per day at any time of the day on an empty stomach or at mealtime.
In normal use, SGLT2 inhibitors do not cause blood sugar to drop too low. After starting the medication, quantity of food should not be increased. Instead, food quantities should be reduced, if there is overweight. The product doses do not need to be adjusted according to alternating eating habits or exercise. When the product is used together with insulin, the need for insulin may be reduced. The insulin dose is reduced on the basis of blood sugar self-measurements and the doctor’s instructions.
For some of the SGLT2 inhibitor products, the treatment of chronic kidney disease or cardiac failure is also an indication.
The blood sugar-lowering effect of SGLT2 inhibitors is reduced if the kidneys are not functioning properly. Doctor will assess the benefits and indication of the product on individual basis, if the glomerular filtration rate or GFR has been significantly reduced.
A recurring or long-term urinary tract infection or susceptibility to yeast infection may also be a contraindication to using the medicine.
The diuretic or anti-hypertensive medicine doses may need to be adjusted at the start of the SGLT2 inhibitor medication. Self-checking blood pressure gives an indication of the effect of the drug on the blood pressure.
SGLT2 inhibitors are not used during pregnancy or breastfeeding.
All pharmaceutical products involve an individual risk of side effects.
SGLT2 inhibitors increase urinary excretion and the risk of dehydration. A high urine sugar level increases the risk of genital yeast infections. The excretion of sodium salt into urine may lower the blood pressure. In insulin-dependent diabetes, SGLT2 inhibitors result in a slightly higher risk of ketoacidosis.
For instructions on how to treat a yeast infection, go to Terveyskirjasto (in Finnish).
