Table 2.

Summary of licensed indications and recommended doses of sodium glucose co-transporter 2 inhibitors in type diabetes

		Dose adjustment recommendations as per kidney functions
SGLT2 inhibitor	Licensed indication	eGFR >60	eGFR 45–59	eGFR 30–44	eGFR <30
Canagliflozin	Adults with insufficiently controlled T2D	Initiate 100 mg, titrate to 300 mg if needed	Initiate / continue with 100 mg only	Initiate / continue with 100 mg only if albuminuria >30 mg/mmol at initiation	Continue established treatment with 100 mg but do not initiate; stop if dialysis/transplant
Dapagliflozin	Adults with insufficiently controlled T2D	Initiate 10 mg	Continue with 10 mg but do not initiate	Not recommended	Not recommended
Dapagliflozin	HFrEF with or without T2D	Initiate 10 mg	Initiate 10 mg	Initiate 10 mg	Limited experience
Empagliflozin	Adults with insufficiently controlled T2D	Initiate 10 mg, titrate to 25 mg if required	Continue with 10 mg only; do not initiate	Not recommended	Not recommended
Ertugliflozin	Glycaemic control only	Initiate 5 mg, titrate to 15 mg if needed	Continue with 5 mg or 15 mg; do not initiate	Not recommended	Not recommended
In appropriate high-risk patients, a decision to treat with an SGLT2 inhibitor to reduce risk of cardiovascular, kidney and/or heart failure events should be considered independent of HbA1c. Canagliflozin and empagliflozin have label indication for reducing major adverse CV events.^9,12 Canagliflozin, dapagliflozin and empagliflozin have shown reduction in hospitalisation for heart failure and to reduce chronic kidney disease progression in CV trials^9,11,12 canagliflozin and dapagliflozin have primary renal outcome data^9,15 canagliflozin is now licenced for the treatment of diabetic kidney disease in T2D⁹ dapagliflozin and empagliflozin have primary heart failure outcome data^16,17 dapagliflozin is now licenced for the treatment of heart failure with reduced ejection fraction in people with or without T2D.¹¹ When used in people with GFR <45, the effect on glucose lowering is likely to be minimal or absent but the medication is still indicated for people with heart failure with reduced ejection fraction.
Further trial results in areas of chronic kidney disease and heart failure are coming which may impact licensed indications in future. Please refer to current SmPC for individual drug for latest information on licenced indications and dose adjustment recommendations.

CV = cardiovascular; eGFR = estimated glomerular filtration rate (mL/min/1.73 m²); HbA1c = glycated haemoglobin; HFrEF = heart failure with reduced ejection fraction; SGLT2 = sodium glucose co-transporter 2; SmPC = summary of product characteristics; T2D = type 2 diabetes. Box colours: green = initiate; yellow = can initiate in certain circumstances; orange = do not initiate but can continue established treatment; red = treatment not recommended.