SGLT2i can be used as add-on second-line therapy in patients with T2DM having mild-to-moderate DKD with the aim to delay the progression of DKD1

Initial reduction in estimated glomerular filtration rate (eGFR) is expected after initiation of SGLT2i, hence close monitoring of patients is recommended.

Patients with eGFR < 60 mL/min/1.73 m2 should be closely monitored as per local practice for renal function parameters.

SGLT2i can be used if eGFR is > 45 mL/min/1.73 m2.

SGLT2i can be continued if eGFR is between 30 and 45 mL/min/1.73 m2.

SGLT2i should be discontinued if eGFR falls below 30 mL/min/1.73 m2.

SGLT2i should not be used in patients with end-stage renal disease or on dialysis.

Patient selection and education should be an integral part of management when initiating SGLT2i.

Caution should be taken when prescribing SGLT2i to patients with a history of prior amputation, severe peripheral vascular disease, neuropathy, foot ulcers, hypersensitivity reactions, euglycemic DKA, and those on diuretic therapy.

Patients should be educated on perineal and genital hygiene and signs and symptoms of mycotic infections; early diagnosis and treatment should be encouraged.