SGLT2 inhibitors in type 2 diabetes mellitus : a pharmacist’s guide to optimised care

Abstract

OBJECTIVES : To review current evidence on sodium–glucose co-transporter-2 (SGLT2) inhibitors in the management of type 2 diabetes mellitus (T2DM), highlighting their mechanisms, efficacy, safety, and relevance to the growing burden of diabetes mellitus within the South African healthcare context, where high rates of undiagnosed disease and limited specialist access amplify the importance of pharmacist-led interventions. This review underscores the vital role of pharmacists as frontline diabetes care providers – facilitating optimal use of SGLT2 inhibitors such as empagliflozin and dapagliflozin through patient counselling, safety monitoring, and therapeutic guidance. METHODS : A narrative literature review was conducted by searching PubMed, Google Scholar, and local databases. Key articles on SGLT2 inhibitors, their effects on cardiovascular and renal outcomes, and prevalence data on T2DM in South Africa were included. Relevant clinical trials and meta-analyses published in English were appraised, with a focus on recent developments and guidelines. RESULTS : Burden of diabetes in South Africa: T2DM prevalence can reach 12.9% or higher in certain urban black populations, exceeding the overall International Diabetes Federation (IDF) estimate of 10.8%. Nearly half (45.4%) of those affected remain undiagnosed. Mechanism and benefits: SGLT2 inhibitors lower blood glucose by enhancing urinary excretion of glucose, providing insulin-independent glycaemic control. They induce weight loss and mild blood pressure reductions. Cardiorenal protection: Large-scale trials conducted in T2DM patients with either established chronic kidney disease or cardiovascular disease or high cardiovascular risk demonstrate meaningful reductions in cardiovascular events, hospitalisation for heart failure, and progression of chronic kidney disease. Safety profile: While generally well tolerated, key adverse effects include genitourinary infections and rare euglycaemic ketoacidosis, especially during acute illness or low-carbohydrate intake. CONCLUSION : SGLT2 inhibitors address both the escalating rates of T2DM in South Africa and its serious complications. Their robust cardiorenal benefits, combined with modest weight loss and minimal hypoglycaemia risk, make them an essential component of contemporary diabetes pharmacotherapy. Pharmacists play a central role in identifying appropriate candidates, advising on safety precautions, and improving patient outcomes in an increasingly burdened healthcare landscape.