From the Guidelines
SGLT2 inhibitors like empagliflozin, dapagliflozin, and canagliflozin offer several important benefits for patients with diabetes, heart failure, or kidney disease, including reducing the risk of heart failure, heart attacks, and kidney disease progression, as well as providing modest weight loss and blood pressure reduction, as noted in the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1. These medications work by helping your kidneys filter out more sugar through your urine, which lowers blood sugar levels. The benefits of SGLT2 inhibitors include:
- Reducing the risk of major cardiovascular adverse events, renal events, and hospitalization rates for heart failure, as seen in the 2019 standards of medical care for type 2 diabetes in China 1
- Providing modest weight loss of about 5-10 pounds and slightly decreasing blood pressure, as reported in the 2018 management of hyperglycemia in type 2 diabetes consensus report 1
- Reducing the risk of all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke, as noted in the 2024 clinical practice guideline on sodium-glucose cotransporter-2 inhibitors for adults with chronic kidney disease 1 However, there are some side effects you should be aware of, including:
- Increased urination, genital yeast infections, and urinary tract infections due to the sugar in your urine, as reported in the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1
- The most serious but rare side effect is Fournier's gangrene, a severe infection affecting the genital area that requires immediate medical attention if you experience pain, redness, or swelling in your genital region along with fever, as noted in the 2018 acc expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease 1
- Other possible side effects include low blood pressure (causing dizziness), diabetic ketoacidosis (especially during illness), and bone fractures in some cases, as reported in the 2018 management of hyperglycemia in type 2 diabetes consensus report 1 Taking these medications requires regular monitoring and maintaining good hygiene to minimize infection risks, as recommended in the 2025 kdoqi us commentary on the kdigo 2024 clinical practice guideline for the evaluation and management of ckd 1.
From the FDA Drug Label
DAPAGLIFLOZIN TABLETS a sodium-glucose cotransporter 2 (SGLT2) inhibitor, are indicated: • To reduce the risk of sustained eGFR decline, end stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression • To reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit in adults with heart failure. • To reduce the risk of hospitalization for heart failure in adults with type 2 diabetes mellitus and either established cardiovascular disease or multiple cardiovascular risk factors • As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus.
The benefits of SGLT2 inhibitors, including dapagliflozin, are:
- Reduced risk of kidney disease progression
- Reduced risk of cardiovascular death and hospitalization for heart failure
- Improved glycemic control in patients with type 2 diabetes mellitus The side effects of SGLT2 inhibitors, including dapagliflozin, may include:
- Increased risk of diabetic ketoacidosis
- Increased risk of urinary tract infections
- Increased risk of genital mycotic infections
- Hypotension and volume depletion, particularly in patients with renal impairment
- Bone fractures, particularly in patients with renal impairment 2
From the Research
Benefits of SGLT2 Inhibitors
- Effective glycaemic control: SGLT2 inhibitors, such as dapagliflozin (Forxiga®), have been shown to provide effective glycaemic control in patients with type 2 diabetes mellitus (T2DM) 3.
- Reduced bodyweight and blood pressure: SGLT2 inhibitors have been found to reduce bodyweight and blood pressure in patients with T2DM 3.
- Cardioprotective effects: Dapagliflozin has been shown to reduce the rate of cardiovascular (CV) death or hospitalization for heart failure (HHF) and possibly reduce progression of renal disease relative to placebo in patients with established atherosclerotic CV disease (CVD) or multiple risk factors for CVD 3.
- Low risk of hypoglycaemia: SGLT2 inhibitors have a low risk of hypoglycaemia, making them a suitable option for patients with T2DM 3.
Side Effects of SGLT2 Inhibitors
- Genital infections: SGLT2 inhibitors have been linked to an increased incidence of genital mycotic infections, with a approximately 3-fold increase in risk compared to other antidiabetic medications 4, 5, 6, 7.
- Urinary tract infections: SGLT2 inhibitors may also increase the risk of urinary tract infections, although the evidence is less consistent 4, 5, 6.
- Diabetic ketoacidosis (DKA): Although rare, DKA is a potential side effect of SGLT2 inhibitors 3.
- Increased risk of genital infections in older adults: The risk of genital infections associated with SGLT2 inhibitors may be more pronounced in older adults (aged ≥60) 7.