[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › SGLT2 inhibitors (gliflozins)

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# SGLT2 inhibitors (gliflozins)

Oral drugs that make the kidney spill glucose into the urine. They also protect the heart and kidneys, beyond lowering glucose.

Updated 2026-11-01

## What they are

Inhibitors of the sodium-glucose cotransporter 2 of the proximal tubule. Used in type 2 diabetes, heart failure and chronic kidney disease.

## Mechanism of action

SGLT2 in the early proximal tubule reabsorbs most of the filtered glucose together with sodium. Gliflozins block it, so glucose and some sodium are lost in the urine (glycosuria and mild osmotic diuresis). Glucose falls without extra insulin, calories are lost, and more sodium reaching the macula densa restores tubuloglomerular feedback, lowering glomerular pressure; this helps explain the kidney and heart benefit.

Target: Sodium-glucose cotransporter 2 (SGLT2, SLC5A2) of the proximal tubule

## Key points

- Euglycemic diabetic ketoacidosis: ketoacidosis with near-normal glucose, typically after surgery, fasting, acute illness or a big cut in insulin.
- Genital fungal infections and urinary tract infections; rarely Fournier gangrene (necrotizing fasciitis of the perineum).
- Reduce heart failure hospitalizations and slow kidney disease, also in patients without diabetes (dapagliflozin, empagliflozin).
- Volume depletion and low blood pressure, especially with diuretics and in older adults.
- Alone they rarely cause hypoglycemia; urine glucose tests turn positive by design.

## Drugs in this class

- [**Dapagliflozin** An SGLT2 inhibitor used in type 2 diabetes, heart failure and chronic kidney disease. Watch for genital infections and… Sodium-glucose cotransporter 2 (SGLT2)](https://durgical.com/en/pharmacology/dapagliflozin/)
- [**Empagliflozin** An SGLT2 inhibitor: makes the kidney lose glucose in urine and lowers heart failure hospitalizations and kidney decline. Sodium-glucose cotransporter 2 (SGLT2)](https://durgical.com/en/pharmacology/empagliflozin/)
- [**Canagliflozin** An SGLT2 inhibitor for type 2 diabetes and diabetic kidney disease, with extra warnings about amputations and fractures. Sodium-glucose cotransporter 2 (SGLT2)](https://durgical.com/en/pharmacology/canagliflozin/)

## Others in the class

- ertugliflozin
- sotagliflozin (also blocks SGLT1)

## Test yourself

Think of the answer, then tap the question to see it.

## Why can SGLT2 inhibitors cause ketoacidosis with a normal glucose level?

Glucose is lost in urine, so blood glucose stays near normal while insulin falls and glucagon rises; fat breakdown and ketone production go on unnoticed.

## Why are genital fungal infections common with gliflozins?

The urine is rich in glucose, which feeds yeasts (mainly Candida) on the genital skin and mucosa.

## Where in the nephron does SGLT2 work?

In the early (S1–S2) segment of the proximal convoluted tubule, where it reabsorbs most filtered glucose with sodium.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Empagliflozin: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a614043.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [DailyMed - DAPAGLIFLOZIN tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b6b8a10c-64c3-4856-8961-d72d68784f5d) (DailyMed (U.S. National Library of Medicine), 2026); [Structure of human SGLT2-MAP17 complex bound with empagliflozin](https://www.rcsb.org/structure/7VSI) (RCSB Protein Data Bank, 2021).

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