Are SGLT2 Inhibitors Safe and Beneficial Beyond Diabetes?
Drugs known as SGLT2 inhibitors are now widely used to treat type 2 diabetes, as well as heart failure and chronic kidney disease. Their increasing use has revealed various effects, some positive and others less so.
These treatments slightly increase the risk of genital infections, especially in people with diabetes. These infections generally remain mild and can be prevented with good hygiene. Urinary tract infections, on the other hand, do not appear to be more frequent than with other medications. In rare cases, serious infections such as Fournier gangrene have been reported, but there is no evidence of an increased risk directly linked to these drugs.
A slight increase in the number of red blood cells in the blood has also been observed. This phenomenon, called erythrocytosis, is usually benign but can sometimes reveal underlying disorders. Doctors should therefore monitor patients and investigate if levels become too high.
A rare but serious side effect is euglycemic diabetic ketoacidosis, a complication where the blood becomes too acidic without very high blood sugar levels. This can occur in cases of prolonged fasting, dehydration, or other stressful situations for the body. Patients should be informed of the warning signs and measures to take to avoid it.
On the unexpected benefits side, these drugs reduce the risk of acute kidney failure and appear to protect against kidney stones. They also improve heart function and reduce hospitalizations for heart failure, even in non-diabetic individuals. Moderate weight loss and an improved lipid profile are also observed, which can be beneficial for metabolic health.
Finally, SGLT2 inhibitors do not appear to increase the risk of bone fractures or lower limb amputations, contrary to what some initial studies suggested. Their impact on the liver is also promising, with a reduction in liver fat in patients with hepatic steatosis.
Overall, these drugs are considered safe and effective, provided that individual risks are properly assessed and patients are monitored, particularly those with specific risk factors. Their use should be tailored to each person, taking into account their medical history and overall health.
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Study Citation
DOI: https://doi.org/10.1007/s00228-026-04023-9
Title: Beyond safety: adverse events and unanticipated advantages of SGLT2 inhibitors
Journal: European Journal of Clinical Pharmacology
Publisher: Springer Science and Business Media LLC
Authors: Lorenzo Falsetti; Nicola Tarquinio; Luciano Mucci; Silvia Santini; Emanuele Guerrieri; Laura Giovenali; Giulia Pierdomenico; Vincenzo Zaccone; Giovanna Viticchi; Gianluca Moroncini