SGLT2is block the reabsorption of glucose by inhibiting the sodium glucose cotransporter 2 receptor. Hence, these agents improve glucose metabolism by promoting renal excretion of glucose irrespective of insulin secretion.

The advantages of SGLT2is in diabetes include – reduction in body weight; improvement in insulin resistance; glucose homeostasis; and prevention of organ damage. Recent evidence suggests that SGLT2i protects against cardiovascular death, development of HF, as well as the progression of kidney disease. Additionally, SGLT2i effectively lowers the liver fat content and reverses hepatic fibrosis. 

Thus, these drugs confer improvements in multiple organs and provide protection against cardiovascular, renal, and hepatic damage. Their mechanisms underlying organ protection, besides glucose-lowering effects include – improvement of insulin resistance for anti-atherogenesis, osmotic diuresis for cardiac protection, fatty acids utilization for hepatic protection, and improvement of tubuloglomerular feedback for renal protection.

Source: International Journal of Molecular sciences. 2021 Apr 23;22(9):4416.doi: 10.3390/ijms22094416.