Table 3.

Who is likely to be at risk with sodium glucose co-transporter 2 inhibitors?

Use with caution in the following situations:

  • Person adhering to a ketogenic diet

  • Body mass index under 25 kg/m2 (under 23 kg/m2 in South Asian patients)

  • Person considered at high risk of acute effects of hyperglycaemia (such as dehydration due to non-adherence to medication)

  • Person with very high level of HbA1c >86 mmol/mol (∼10% in old HbA1c units)

  • People diagnosed with or at risk of frailty

  • Cognitive impairment as it may interfere with the adequate understanding to take action to prevent and identify DKA

  • On chronic oral steroids

  • Recent weight loss

  • Long duration of diabetes (generally over 10 years from diagnosis)

Avoid in the following situations:

  • Past history of diabetic ketoacidosis

  • Eating disorder

  • eGFR lower than allowed in the up-to-date licensing of the medication being considered

  • Person with excess alcohol consumption or IVDU

  • Unwell person (acute medical illness including COVID-19, surgery or planned medical procedure)

  • Any diagnosis or suspicion of diabetes due to other causes, including T1D,a latent autoimmune diabetes (LADA), other genetic causes of diabetes, known pancreatic disease or injury, or people who rapidly progressed to needing insulin within 1 year of diagnosis

  • Pregnant, breast feeding, female in the child-bearing years and sexually active without contraception

  • Age <18 years

  • Suspected or possible T1D except under specialist supervision (dapagliflozin 5 mg only)a

  • Inpatient with acute vascular event who is not stable

  • Seek advice from the local diabetes team if unsure about the benefits and risks. aOnly dapagliflozin 5 mg is licensed for use in T1D in certain circumstances and should be initiated and supervised by a specialist. Sotagliflozin (SGLT1+2 inhibitor) 200 mg is also approved by NICE for similar circumstances but not currently available in the UK. eGFR = estimated glomerular filtration rate; DKA = diabetic ketoacidosis; HbA1c = glycated haemoglobin; IVDU = intravenous drug users; NICE = National Institute for Health and Care Excellence; T1D = type 1 diabetes.