While no single drug has been shown to reduce both cardiovascular mortality and improve renal outcomes, SGLT2 inhibitors have been making headlines for their benefits against major adverse cardiovascular outcomes and improved renal outcomes in patients with T2DM and CVD. Recent studies have demonstrated a benefit for SGLT2 inhibitors in patients with heart failure and kidney disease both in the presence and absence of T2DM. Their use is also associated with additional advantages including improvements in fluid status, blood pressure, serum uric acid levels, and weight loss. 

Existing evidence suggests that SGLT2 inhibitors should be used in all eligible patients with HFrEF and/or CKD with albuminuria to reduce the advancement of CKD, hospital admissions for heart failure, major atherosclerotic cardiovascular events, and cardiovascular death, with and without T2DM. The cardiovascular and renal benefits have repeatedly been shown across the class of SGLT2 inhibitors in their respective CVOTs. The superiority of an SGLT2 inhibitor added to the standard of care for CKD in T2DM for a primary outcome of kidney disease end pints has been demonstrated in different trials. 

Currently, there are four SGLT2 inhibitors approved by the US Food and Drug Administration for the treatment of hyperglycemia in T2DM-canagliflozin, empagliflozin, dapagliflozin, and ertugliflozin. The magnitude of cardiac and renal protection seen with SGLT2 inhibitors has not been seen in any other glucose-lowering drug. 

Reference: Singhal R, Hechanova LA. SGLT2 inhibitors: Benefits for CKD and cardiovascular disease in type 2 diabetes. Curr Cardiol Rep. 2022 Feb 11. DOI: 10.1007/s11886-022-01637-0