Approach to the patient with type 2 diabetes treated with SGLT-2 inhibitor: art of effective and safe prescription

Sodium glucose cotransporter-2 (SGLT-2) inhibitors are shown to improve cardiovascular and renal outcomes in people with type 2 diabetes, and their use in primary care and subspecialty clinics continues to grow. However, their prescription remains underused. One of the obstacles precluding wider use of these agents is providers' fear of causing more likely immediate side effects over waiting for improvements in morbidity and mortality that are accrued with chronic SGLT-2 inhibitor prescription. One of the concerns is an increased risk of genitourinary infections. Recently, several effective strategies were suggested by the experts that can be used to mitigate the infection risk. Another barrier is development of diabetic ketoacidosis. Fortunately, there is a growing body of knowledge for strategies that may help avoid diabetic ketoacidosis. Finally, a novel postmarketing observation reported by several groups over the past few years suggested that SGLT-2 inhibitor can cause erythrocytosis, which paradoxically can detrimentally impact cardiovascular health. This clinical case-based article will discuss and summarize newest developments in the field and allow practitioners to become more confident in using gliflozin therapy.