SGLT2 Inhibitors in Type 2 Diabetes Mellitus: A Comparative Review of Efficacy, Cardiovascular and Renal Benefits, and Cost

Abstract Introduction: Type 2 diabetes mellitus (T2DM) is increasingly prevalent, highlighting the need for effective and accessible treatment options. This review evaluates the efficacy, cardiovascular and renal benefits, and cost-effectiveness of SGLT2 inhibitors. Review of Literature: To better understand the cost and efficacy of SGLT2 inhibitors, clinicians should first consider the pathophysiology, benefits, and other prescriber considerations. Search Method: Systematic literature searches were conducted between January and November 2025 using PubMed, CINAHL, and MEDLINE. Current retail medication prices were obtained primarily from GoodRx or CostPlus Drug Company. Results: SGLT2 inhibitors lower HgA1C while also reducing body weight and systolic blood pressure, providing cardiovascular protection, and slowing chronic kidney disease progression. Five SGLT2 inhibitors are approved for treatment of T2DM: bexagliflozin, canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. Discussion: To determine which SGLT2 inhibitor to prescribe, clinicians should compare cost with metabolic, cardiovascular, and renal benefits. Implications for Practice: Bexagliflozin is the least expensive option. Canagliflozin offers the greatest HbA1C reduction, empagliflozin has the strongest cardiovascular benefits, and all SGLT2 inhibitors provide renal benefits. Conclusion: SGLT2 inhibitors are foundational in evidence-based T2DM management, offering glycemic, cardiovascular, and renal benefits. Selection should be individualized based on patient comorbidities, renal function, affordability, and tolerability.