Adequate Renal Function Needed
The SGLT2 inhibitors rely on adequate renal function. They rely on a sufficient glomerular filtration to put glucose into the proximal tubule so its reabsorption can be inhibited. As glomerular filtration declines, the efficacy is likely to decline as well, and for this reason, in individuals who have particularly low glomerular filtration rates, SGLT2 inhibitor therapy would not be indicated because the efficacy would be inadequate.
Chronic kidney disease is an issue in advancing years in patients with type 2 diabetes, and so that is one of the precautions that needs to be seriously considered when choosing to use this type of therapy. That said, because this type of therapy is non-insulin dependent, it can be used early in the progression of type 2 diabetes as an add-on to the monotherapies that we have available at the moment. If renal function is adequate renal function, one can see the glucose-lowering effect of the drug, either weight-lowering or prevention of weight gain, and perhaps some reduction in blood pressure. In the case of adding this therapy to insulin, it is usually possible to either slightly or considerably reduce the amount of insulin, and certainly to reduce or avoid the need for titrating up the insulin. The SGLT2 inhibitor should fit as a non-insulin-dependent agent with any other therapies at any stage of disease to help control hyperglycemia, given adequate renal function.
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Cite this: Where Do SGLT2 Inhibitors Fit in Diabetes Care? - Medscape - Oct 15, 2013.