SGLT2 inhibitors and diabetes-related foot disease

Q: SGLT2 inhibitors (sodium-glucose cotransporter-2 (SGLT2) inhibitors, also called "flozins" have an extra advantage in patients with active diabetic foot ulcerations by advancing healing.

A) True

B) False

Answer: B

SGLT2 inhibitors should be avoided in the following groups of patients:

• frequent bacterial urinary tract infections (UTIs) 
• genitourinary (GU) yeast infections
• low bone density 
• high risk for falls and fractures
• active foot ulceration
• risks for diabetic ketoacidosis 
• pancreatic insufficiency
• drug or alcohol use disorder
• NPO status

SGLT2 inhibitors, particularly canagliflozin, are associated with an added risk of lower extremity infection and amputation. Diabetic patients with neuropathy, foot deformity, vascular disease, and history of previous foot ulceration should be cautioned and examined frequently if SGLT2 drugs are used.

#endocrine

References: 

1. Halimi S, Vergès B. Adverse effects and safety of SGLT-2 inhibitors. Diabetes Metab. 2014 Dec;40(6 Suppl 1):S28-34. doi: 10.1016/S1262-3636(14)72693-X. PMID: 25554069.

2. Highton P,  & et.al: The use of SGLT2 inhibitors in people with diabetes-related foot disease: A Delphi-based consensus study. Diabetes Obes Metab. 2025 Aug;27(8):4537-4546. doi: 10.1111/dom.16498. Epub 2025 Jun 11. PMID: 40495570; PMCID: PMC12232341.