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SGLT2i No Hypoglycaemia Non-Diabetic — ESENeph MCQ

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EasyChronic Kidney DiseaseSGLT2i No Hypoglycaemia Non-DiabeticESENeph

A 40-year-old man with CKD G3b on Dapagliflozin notices his HbA1c has improved but his random blood glucose is 3.2 mmol/L. He is not diabetic. Should hypoglycaemia be a concern with SGLT2i in non-diabetic patients?

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Correct answer: D — No – SGLT2i do not cause hypoglycaemia in non-diabetic patients because they only reduce glucose when it is above the renal threshold for reabsorption; counter-regulatory mechanisms prevent hypoglycaemia

SGLT2 inhibitors block glucose reabsorption in the proximal tubule only when filtered glucose exceeds the transport capacity. In normoglycaemic patients, the amount of glucose blocked is minimal and counter-regulatory hormones (glucagon, catecholamines) maintain euglycaemia. SGLT2i monotherapy does not cause hypoglycaemia. The blood glucose of 3.2 in this patient likely has another cause (fasting, analytical variation). In diabetic patients on insulin or sulfonylureas, SGLT2i may increase hypoglycaemia risk from those agents, not from the SGLT2i itself.

Reference: KDIGO 2024 – CKD; DAPA-CKD Safety Data; EMPA-KIDNEY Safety Data