From the Guidelines
SGLT2 inhibitors do not appear to significantly increase the risk of pancreatitis, and may have a neutral or potentially protective effect against pancreatitis compared to other diabetes medications. The most recent and highest quality study, published in 2025 1, suggests that SGLT2 inhibitors have a mechanism of action that doesn't directly affect pancreatic function, and post-marketing surveillance and large clinical trials have not identified pancreatitis as a significant adverse effect of SGLT2 inhibitors. Some studies, such as the 2024 study 1, note that caution should be exercised in persons with a history of acute pancreatitis, but this does not necessarily imply a significant increased risk. The main side effects to be aware of with SGLT2 inhibitors include:
- Genital mycotic infections
- Urinary tract infections
- Volume depletion
- Rare but serious conditions like diabetic ketoacidosis and Fournier's gangrene In contrast, other diabetes medications such as GLP-1 receptor agonists or DPP-4 inhibitors have been associated with pancreatitis concerns 1. Therefore, SGLT2 inhibitors can be considered a safe option for patients with type 2 diabetes, including those with a history of pancreatitis, as long as individual risk factors are discussed with a healthcare provider.
From the Research
SGLT2 Inhibitors and Pancreatitis Risk
- The relationship between Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors and the risk of pancreatitis has been investigated in several studies 2, 3, 4, 5.
- A 2022 study found a potential risk of pancreatitis with the use of SGLT2 inhibitors, with empagliflozin, canagliflozin, and dapagliflozin having the highest risk 2.
- Another study from 2024 reported a case of acute pancreatitis secondary to dapagliflozin, highlighting the importance of clinical suspicion in patients recently started on these drugs 3.
- However, a 2020 systematic review and meta-analysis found that SGLT2 inhibitors were not associated with an increased risk of acute pancreatitis compared to controls, although the quality of evidence was moderate 4.
- A 2024 case report also suggested an association between SGLT2 inhibitors and acute pancreatitis, although extensive research is warranted to consolidate this association 5.
- An earlier study from 2015 examined the relationship between different anti-diabetic therapies, including DPP-4 inhibitors, metformin, and sulfonylureas, and the risk of acute pancreatitis, but did not specifically investigate SGLT2 inhibitors 6.
Key Findings
- SGLT2 inhibitors may be associated with an increased risk of pancreatitis, although the evidence is not consistent across all studies 2, 3, 5.
- The quality of evidence for the association between SGLT2 inhibitors and pancreatitis risk is moderate to very low 4.
- Further research is needed to fully understand the relationship between SGLT2 inhibitors and pancreatitis risk 2, 5.