Navigating the Complexities of SGLT-2 Inhibitor Therapy: Balancing Benefits and Risks for Type 2 Diabetes Management

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors have emerged as potent oral hypoglycemic drugs for managing type 2 diabetes, offering significant benefits such as improved cardiovascular and renal functions along with weight loss. However, their usage is accompanied by various risks, including urinary tract infections, vulvovaginal candidiasis, reduced bone mineral density, and the rare but serious condition known as euglycemic diabetic ketoacidosis (EDKA). Despite initial authorizations with perceived benefits outweighing risks, subsequent warnings by the FDA and recent studies have highlighted the elevated risk of diabetic ketoacidosis (DKA) associated with SGLT-2 inhibitors. This risk, particularly EDKA, presents diagnostic challenges due to attenuated hyperglycemia, potentially delaying accurate diagnosis and intervention. Furthermore, the lack of awareness and data in Asian regions underscores the importance of increased vigilance and research into the side effects of these drugs. Clinicians are advised to educate patients about potential adverse effects, consider discontinuation during certain conditions, and utilize advanced glucose meters for the early detection of DKA. This letter emphasizes the critical need for awareness, monitoring, and further investigation into the complexities surrounding SGLT-2 inhibitor therapy in type 2 diabetes management.