Sodium-Glucose Cotransporter 2 Inhibitors: An Overview

Essie Samuel, PharmD, BCPS; Jiehyun Lee, PharmD, BCACP, CACP


US Pharmacist. 2017;42(10):42-47. 

In This Article

Abstract and Introduction


The management of type 2 diabetes (T2DM) has evolved significantly over the past several decades. One of the newest additions to antidiabetic therapy is a sodium-glucose cotransporter 2 (SGLT2) inhibitor with a unique mechanism that targets the kidney's ability to reabsorb filtered glucose. In addition to providing glycemic control, this class has a unique mechanism of action associated with blood pressure reduction, weight loss, and potential cardiovascular benefits; however, the FDA is closely monitoring the use of these drugs based on increased safety concerns. The benefits and risks of SGLT2 inhibitors should be carefully considered. Selected patients with T2DM can benefit from SGLT2 inhibitor therapy.


Diabetes, a devastating disease affecting more than 29 million Americans, is a growing epidemic and the leading cause of end-stage renal disease, lower-limb amputation, and blindness in the United States. In addition, cardiovascular (CV) events are highly prevalent in patients with diabetes.[1]

Metformin is the recommended first-line drug for type 2 diabetes (T2DM) patients with poor glycemic control. However, the glycemic response produced by metformin is typically inadequate in the long-term management of diabetes, and patients will eventually require additional treatments. The need for newer agents to treat T2DM is now being recognized. Most agents used for T2DM either improve the body's sensitivity to insulin or increase pancreatic secretion of insulin. Improved understanding of the mechanisms involved in glucose reabsorption through the kidneys has led to the development of sodium-glucose cotransporter 2 (SGLT2) inhibitors. At this writing, three agents in this class have been approved by the FDA: canagliflozin, dapagliflozin, and empagliflozin (Table 1).[2,3]