Why Not Prescribe a SGLT2 Inhibitor for This Patient?


The sodium glucose cotransporter-2 inhibitors have many advantages eg, modest A1c reduction and low hypoglycemia risk. But careful patient selection is critical.

A 76-year-old African American woman with a history of type 2 diabetes mellitus and chronic kidney disease is evaluated for an elevated A1c level of 7.6% (American Diabetes Association goal, <7%). Current medications include metformin, 1000 mg twice daily; glimepiride, 8 mg/d; lisinopril, 20 mg/d; carvedilol, 25 mg twice daily; furosemide, 40 mg twice daily; aspirin, 81 mg/d; and atorvastatin, 80 mg/d. Recent laboratory findings are significant for an estimated glomerular filtration rate (eGFR) of 50 mL/min/1.73 m2. The patient would like to try the “new diabetes drug” she saw advertised on TV, but you inform her that she cannot take canagliflozin at this time.


Why would you NOT recommend canagliflozin at this time?

A. Canagliflozin will not lower her A1c to goal.
B. Canagliflozin is not recommended with an eGFR of less than 60 mL/min
C. Canagliflozin cannot be combined with sulfonylureas (glimepiride).
D. Canagliflozin is not recommended because of the patient’s risk for hypotension.
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