Sodium-glucose cotransporter 2 (SGLT2) inhibitors have a number of adverse effects—the most serious of which are diabetic ketoacidosis and necrotising fasciitis of the perineum.

Clinicians should educate patients to temporarily stop taking their SGLT2 inhibitor when acutely unwell with reduced oral intake, to reduce their risk of diabetic ketoacidosis and acute kidney injury, and this education is especially important during the coronavirus disease 2019 (COVID-19) pandemic.

In very large randomised controlled trials, SGLT2 inhibitors have been associated with a lower risk of acute kidney injury. These drugs should not, however, be prescribed to a patient who is hypovolaemic or hypotensive, and a patient’s loop and/or thiazide diuretic dose may need to be reduced.