Adverse Effects of Sglt2 Inhibitors - A Literature Review

Introduction: Sodium‑glucose cotransporter‑2 (SGLT2) inhibitors have rapidly become foundational in the management of type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and heart failure (HF), offering robust glycemic control and cardioprotective and renoprotective benefits. However, despite their favorable efficacy profile, clinicians must recognize and monitor for known adverse events associated with this drug class. Aim of the study: The aim of this study was to systematically analyze and synthesize current evidence regarding the adverse effects associated with sodium–glucose cotransporter 2 (SGLT2) inhibitors. Particular emphasis was placed on identifying the most frequently reported complications, evaluating their underlying mechanisms, and assessing their clinical relevance in various patient populations. The study also sought to determine potential risk factors predisposing patients to these adverse outcomes and to discuss implications for clinical practice. Material and methods: This study was designed as a review of the available literature. A structured search of biomedical databases was undertaken to identify peer-reviewed publications addressing adverse effects associated with SGLT2 inhibitors. Eligible sources included original research articles, randomized controlled trials, meta-analyses, and systematic reviews. Studies were selected according to their relevance and scientific rigor. Extracted data focused on the frequency, mechanisms, and clinical implications of reported adverse events. The collected evidence was synthesized descriptively to present a comprehensive overview of the safety profile of this therapeutic class. Results and Conclusions: Common complications include genitourinary infections, especially genital mycotic infections, which are consistently reported across studies, and urinary tract infections, though the latter’s magnitude of risk may vary by agent and population subgroup. Meta‑analyses suggest increased risks of diabetic ketoacidosis, particularly in its euglycemic form, and osmotic diuresis‑related events such as volume depletion and hypotension. Serious but rare events identified in pharmacovigilance data include limb amputations. While SGLT2 inhibitors may not significantly elevate overall serious adverse event incidence in controlled settings, the risk profile requires careful patient selection and monitoring. SGLT2 inhibitors retain an overall favorable benefit–risk balance when used appropriately. Nevertheless, clinicians should maintain vigilance for specific complications—especially genitourinary infections and metabolic disturbances—and tailor therapy with risk stratification and preventive strategies. Continued surveillance and research are warranted to optimize long‑term safety.