SGLT2 inhibitors are an important weapon in our arsenal against not only type 2 diabetes but also the conditions that we encounter that go hand-in-hand, including CKD and CVD.

Frontline clinicians should initiate SGLT2 inhibitors for patients with type 2 diabetes and diabetic kidney disease who have an eGFR of at least 30 mL/min/1.73 m².

Deferring initiation of SGLT2 inhibitors to a specialist (a nephrologist or endocrinologist) will result in a faster progression of diabetic kidney disease irrespective of glycemic control, and it is crucial to initiate these medications as early as possible.

Prescribers should be aware of the initial reversible drop in eGFR of approximately 5 to 8 mL/min/1.73 m² (up to a 20% drop) in the first 2 weeks after starting SGLT2 inhibitors, which is due to the hemodynamic effects of the drug.

The use of an SGLT2 inhibitor can slow the decline in GFR, reduce the onset of microalbuminuria and slow or reverse the progression of proteinuria.