Sodium–glucose co-transporter 2 inhibitors

Question 1

What is it indicated for?

Answer 1

Type 2 diabetes
Heart failure with reduced ejection fraction
CKD with albuminuria

Question 2

How do they work?

Answer 2

They inhibit the SGLT2 in the proximal convoluted tubule of the nephron. SGLT2 mediates active transport glucose and sodium from filtrate into blood thereby causing renal excretion of glucose.

Question 3

What are the side effects of SGLT2 inhibitors?

Answer 3

They rarely cause hypoglycaemia but can exacerbate it.
Thirst
Hypovolaemia and electrolyte disturbance
Increased risk of genital and urinary tract infections

Question 4

What are the warnings for this drug class?

Answer 4

Withhold intercurrent illness that causes or presents risk of volume depletion or hypotension

Question 5

What are the possible interactions of this drug class?

Answer 5

Increased risk of hypoglycaemia with other anti diabetics
Blood-pressure lowering drugs increased risk of hypotension
Diuretics increased risk of volume depletion

Question 6

What are MHRA warnings?

Answer 6

1. DKA
2. Monitor ketones in blood during treatment interruption for srtugeical procedures of acute serious illness
3. Fournier’s gangrene- a rare but serious and potentially life-threatening infection;
   pain, tenderness, erythema, or swelling in the genital or perineal area,
4. Dapafliflozin 5mg should be NOT be used in T1DM