SGLT2 inhibitors are prescription medicines that can lower blood glucose and reduce kidney or heart-related risks for some people with type 2 diabetes. Their role depends on a person’s kidney function, heart conditions, other medicines and safety risks—not just their A1C. The guidance below is for human healthcare in the United States; it is not veterinary advice and should not be applied to pets.
What are SGLT2 inhibitors used for?
SGLT2 inhibitors are a class of prescription medicines used in type 2 diabetes. Depending on the medicine and the patient’s clinical situation, treatment may be chosen for glucose management, kidney protection, heart failure, or cardiovascular risk reduction. These are not interchangeable indications: eligibility and approved uses differ by drug, so the specific product’s current FDA labeling and a clinician’s assessment matter.
Type 2 diabetes with chronic kidney disease
The American Diabetes Association’s 2026 guidance recommends an SGLT2 inhibitor with demonstrated benefit for people with type 2 diabetes and chronic kidney disease when eGFR is at least 20 mL/min/1.73 m². It recommends continuing the medicine if tolerated until dialysis begins. The eGFR threshold is a guideline criterion, not a guarantee that every SGLT2 inhibitor is suitable for every person or indication; check the individual drug’s labeling.
Heart failure and cardiovascular risk
ADA 2026 recommends an SGLT2 inhibitor for people with type 2 diabetes and heart failure. It also supports cardioprotective medicines, including SGLT2 inhibitors where appropriate, for specified groups with atherosclerotic cardiovascular disease, elevated cardiovascular risk or chronic kidney disease. In the situations specified by the guidance, these choices are based on the person’s comorbidities and risk—not solely on A1C.
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What should be reviewed before starting?
Before treatment, the prescriber should confirm the reason for choosing the medicine and review the person’s current health, other medicines and ability to follow safety instructions. FDA labeling for empagliflozin (Jardiance) and dapagliflozin (Farxiga) directs clinicians to assess renal function before initiation and as clinically indicated. It also advises assessing volume status in people more susceptible to volume depletion and correcting volume depletion before starting.
- Kidney function: Review current eGFR and the specific medicine’s label for the intended indication.
- Hydration, blood pressure and diuretics: Consider low blood pressure, volume depletion and medicines that increase fluid loss, including diuretics.
- Ketoacidosis risk: Discuss prior ketoacidosis and circumstances that can raise risk, such as illness, reduced food or fluid intake, surgery, or reduced insulin where relevant.
- Infection history: Review relevant genital or urinary infection history and what symptoms should prompt a call.
- Procedures and fasting: Tell the care team about planned surgery or procedures involving prolonged fasting before the treatment plan is set.
- Combination medicines: Review insulin or insulin secretagogues, since the overall regimen can affect hypoglycemia risk.
What monitoring is needed during treatment?
There is no single lab-testing interval established by the reviewed FDA labels for everyone taking an SGLT2 inhibitor. Follow-up should be individualized. FDA labeling advises checking renal function as clinically indicated and paying attention to symptoms of volume depletion, particularly for older adults, people with impaired renal function or low blood pressure, and people taking diuretics.
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Kidney function and volume status
The clinician may reassess kidney function and hydration based on the person’s health, response to treatment and changes in medicines or illness. Report concerning dizziness, faintness or other symptoms that may reflect low blood pressure or dehydration rather than waiting for a routine appointment.
Blood glucose and hypoglycemia with other medicines
Low blood glucose risk depends in part on the full treatment regimen. If an SGLT2 inhibitor is used with insulin or an insulin secretagogue, the prescriber may consider adjusting that medicine. Do not reduce or stop insulin or another diabetes medicine on your own; ask the treating clinician for an individualized plan.
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Can ketoacidosis happen if blood sugar is not very high?
Yes. FDA labeling warns that ketoacidosis should be considered when symptoms suggest it even if blood glucose is not very high. Illness, reduced food or fluid intake, dehydration, surgery and reduced insulin where relevant can contribute to risk. Seek urgent medical assessment for possible ketoacidosis symptoms, such as nausea, vomiting, abdominal pain, unusual tiredness or difficulty breathing, and tell the clinician that you take an SGLT2 inhibitor.
Who may need ketone-monitoring tools?
Ketone meters are not a routine requirement for every SGLT2 inhibitor user. ADA’s 2025 guidance calls for education and appropriate ketone-measurement tools for selected people using SGLT inhibition who have type 1 diabetes or are ketosis-prone or following a ketogenic diet. A clinician should determine whether a ketone meter is appropriate and explain when and how to use it; do not use a reading to replace urgent care or a personalized plan.
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Which infection symptoms need attention?
Genital yeast infections and serious urinary infections are recognized risks. Contact a healthcare professional promptly about concerning genital or urinary symptoms, such as pain, burning, fever or worsening discomfort. Severe pain or swelling in the area between the genitals and anus, especially with fever or feeling very unwell, needs urgent evaluation: FDA labeling warns of a rare, serious infection called Fournier gangrene.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.When should an SGLT2 inhibitor be held for surgery or fasting?
For empagliflozin and dapagliflozin, the reviewed FDA labels advise withholding the medicine for at least three days, if possible, before surgery or procedures associated with prolonged fasting. Tell both the prescribing and procedural teams about the medicine in advance. They should give instructions on when to stop and when to restart it; do not make a restart decision based only on a general rule.
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How should a person choose among SGLT2 inhibitors?
The choice should match the clinical goal and the particular medicine’s label. A clinician may weigh the following factors rather than treating the class as one interchangeable option:
- Whether the priority is kidney, heart failure or cardiovascular risk reduction, glucose management, or more than one goal.
- Current eGFR and the drug’s approved indications and kidney-function labeling.
- Volume status, blood pressure and use of diuretics.
- Ketoacidosis risk and the ability to follow illness, fasting and perioperative instructions.
- Genital or urinary infection history, tolerability, access and patient preference.
Discuss the choice and monitoring plan with the prescribing clinician. The recommendations summarized here are U.S.-focused; labeling and clinical guidance may differ in other countries.
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