Table 2.

Suggested adjustment of concomitant diabetic and non-diabetic medication when initiating an SGLT2 inhibitor [43, 93]

Medication	Suggested adjustment
Diabetes
Insulin	Consider reducing dose if HbA1c < 8.0%. However, do not excessively reduce insulin dose (for example, > 20%) as this increases the risk of DKA
Sulfonylurea	Consider reducing dose or stopping if HbA1c < 8.0%
	In patients with advanced CKD, SGLT2 inhibitors have limited anti-hyperglycaemic efficacy due to reduced glycosuria, which should factor into decisions about potentially changing other diabetes medications. Insulin doses need to be reduced in advanced CKD due to an increased half-life of the drug irrespective of concomitant SGLT2 inhibitor use
Non-diabetes
Loop and/or thiazide diuretics	Consider reducing dose of diuretic if systolic blood pressure < 120 mmHg. If evidence of dehydration based on fluid balance assessment, recommend reducing dose or stopping diuretic and only starting SGLT2 inhibitor when dehydration resolved

DKA diabetic ketoacidosis, CKD chronic kidney disease, HbA1c glycated haemoglobin, SGLT2 sodium-glucose cotransporter 2