Sodium-glucose transporter inhibitors 2 in acutely ill patients

PURPOSE OF REVIEW: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have rapidly become central to the management of heart failure and chronic kidney disease. Their widespread use now extends into the peri-acute and critical-care setting, raising questions about whether these agents should be continued or initiated during acute illness. This review summarizes the latest physiological and clinical evidence relevant to these scenarios. RECENT FINDINGS: Recent studies have clarified the physiological and clinical effects of SGLT2 inhibitors during acute illness across perioperative, cardiac, and intensive-care settings. Overall, these agents appear renally safe and may promote modest diuresis and decongestion, though this can be accompanied by slightly greater vasopressor requirements in unstable patients. Their metabolic and anti-inflammatory effects remain favorable, and no consistent safety concerns have been identified. SUMMARY: SGLT2i appear safe for most hemodynamically stable hospitalized or critically ill patients and may confer renal and metabolic benefits. Routine initiation in unselected populations is not supported, but continuation of chronic therapy seems reasonable when patients are stable, euvolemic, and receiving nutrition. Ongoing investigations will clarify optimal timing, dosing, and patient selection for acute-care use.