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SGLT2 inhibitors and lower limb amputations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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SGLT2 inhibitors (SGLT2i) and lower limb amputations

  • a systematic review and meta-analysis concluded that (1):
    • there was no consistent evidence of SGLT2i exposure and increased risk of amputation. The increased risk of amputation seen in the large, long-term Canagliflozin Cardiovascular Assessment Study (CANVAS) trial for canagliflozin, and select observational studies, merits continued exploration

  • a Korean database study (n=219900) concluded that (2)
    • initiating SGLT2is against dipeptidyl peptidase-4 inhibitors did not increase the risk of amputation across patient populations of varying vulnerability


  • Heyward J, Mansour O, Olson L, Singh S, Alexander GC. Association between sodium-glucose cotransporter 2 (SGLT2) inhibitors and lower extremity amputation: A systematic review and meta-analysis. PLoS One. 2020 Jun 5;15(6):e0234065. doi: 10.1371/journal.pone.0234065. PMID: 32502190; PMCID: PMC7274434.
  • Park, S, Jeong, HE, Bea, S, et al. Safety of sodium-glucose co-transporter-2 inhibitors on amputation across categories of baseline cardiovascular disease and diuretics use in patients with type 2 diabetes. Diabetes Obes Metab. 2023; 1-11. doi:10.1111/dom.15221

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