Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors for Diabetes Mellitus

The references listed below are used in this DynaMed topic primarily to support background information and for guidance where evidence summaries are not felt to be necessary. Most references are incorporated within the text along with the evidence summaries.

1. American Diabetes Association (ADA). Standards of Care in Diabetes - 2025. Diabetes Care 2025 Jan 1;48(Supplement_1)S1-359.
2. Scheen AJ. Sodium-glucose cotransporter type 2 inhibitors for the treatment of type 2 diabetes mellitus. Nat Rev Endocrinol. 2020 Oct;16(10):556-577.
3. Cowie MR, Fisher M. SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control. Nat Rev Cardiol. 2020 Dec;17(12):761-772.
4. Xu B, Li S, Kang B, Zhou J. The current role of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes mellitus management. Cardiovasc Diabetol. 2022 May 25;21(1):83.

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• American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) grading system for recommendations:
  • Classes of recommendations:
    • Class I (Strong) - should be performed or administered; indicated/useful/effective/beneficial
    • Class IIa (Moderate) - reasonable to perform or administer; can be useful/effective/beneficial
    • Class IIb (Weak) - may be considered; usefulness/effectiveness is unknown/unclear/uncertain or not well established
    • Class III: No Benefit (Moderate) - should not be performed or administered; not indicated/useful/effective/beneficial
    • Class III: Harm (Strong) - should not be performed or administered; potentially harmful, causes harm, or associated with excess morbidity/mortality
  • Levels of evidence:
    • Level A - high-quality evidence from > 1 randomized controlled trial (RCT), meta-analyses of high-quality RCTs, or ≥ 1 RCTs corroborated by high-quality registry studies
    • Level B-R (Randomized) - moderate-quality evidence from ≥ 1 RCTs or meta-analysis of moderate-quality RCTs
    • Level B-NR (Nonrandomized) - moderate-quality evidence from ≥ 1 well-designed, well-executed nonrandomized studies, observational studies, or registry studies, or meta-analysis of such studies
    • Level C-LD (Limited data) - randomized or nonrandomized observational or registry studies with limitations of design or execution, meta-analyses of such studies, or physiological or mechanistic studies in human subjects
    • Level C-EO (Expert opinion) - consensus of expert opinion based on clinical experience
  • Reference - 2022 AHA/ACC/HFSA guideline on management of heart failure (J Am Coll Cardiol 2022 May 3;79(17):e263), correction can be found in J Am Coll Cardiol 2023 Apr 18;81(15):1551

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