Lower urinary tract symptoms should be queried when initiating sodium glucose co-transporter 2 inhibitors
Open accessAbstract
The sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce the risk of both macrovascular (myocardial infractions and stroke) (1) and microvascular events (progression of CKD) (2) in persons with type 2 diabetes. The beneficial effects of SGLT2i are derived from a cascade of effects subsequent to inhibition of glucose reabsorption in the S1 segment of the proximal tubule. Clinical trials have shown that SGLT2i reduce the absolute risk of kidney failure by 35% (95% CI, 54% to 81%) relative to placebo (2). Thus, SGLT2i may be one of the most important interventions provided for adults at high risk for kidney failure. With any intervention, side effects and adverse effects must be considered to identify patients appropriate for the intervention and to ensure that treated patients are educated regarding potential side effects and the appropriate coping mechanisms for bothersome side effects. For the SGLT2i drug class, adverse events includes hypoglycemia, ketoacidosis, volume depletion (especially when combined with loop diuretics), and genital urinary infections (3⇓⇓–6). Other important side effects that are not life threatening, but are nevertheless bothersome, are lower urinary tract symptoms (LUTS). Below, we describe reasons why LUTS should be queried in patients before initiating SGLT2i and methods for managing LUTS to maintain adherence with this drug class. LUTS include urinary frequency and urgency, with or without incontinence. Urinary urgency, or the sudden urge to…
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Euglycemic diabetic ketoacidosis (DKA) is a rare but potentially serious phenomenon associated with treatment with SGLT2 inhibitors, especially in those with multimorbidity who reside in post-acute and long-term care (PALTC) settings, with infection being the most common trigger.
“Euglycemic diabetic ketoacidosis (DKA) is a rare but potentially serious phenomenon associated with treatment with SGLT2 inhibitors, especially in those with multimorbidity who reside in post-acute and long-term care (PALTC) settings, with infection being the most common trigger”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [145]
SGLT2 inhibitors typically increase urine volume.
“Because SGLT2 inhibitors typically increase urine volume”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [145]
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References 10 · Cited by 28
- Authors
- Krepostman, N., & Kramer, H.
- Affiliations
- Loyola University Chicago (US)
- ORCID
- Kramer, Holly
- Venue
- Kidney360
- Published
- 2021-04
- Volume
- 2
- Issue
- 4
- Pages
- 751-754
- ISSN
- 2641-7650 (ISSN-L)
- PMC
- PMC8791328
- OpenAlex
- W3126436930
- Cited by
- 28
- References
- 10
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 8 · 2023: 1
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Kidney360 (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK104842-01)
- Topics
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Epidemiology › Urinary Tract Infections Management
- Keywords
- SGLT2 inhibitors, lower urinary tract symptoms, overactive bladder, urinary urgency, urinary incontinence, type 2 diabetes, adverse drug reactions, medication adherence, diabetic neuropathy, osmotic diuresis, detrusor hypertrophy
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Glucose, Humans, Sodium, Sodium-Glucose Transporter 2, Lower Urinary Tract Symptoms
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