Therapeutic options in the treatment of Type 2 Diabetes Mellitus have expanded significantly in recent years, as numerous new classes of medications have become available.
Since 2014, all newly introduced glucose-lowering medications have been required to undergo large-scale safety studies involving significant patient populations. Fortunately, no concerning safety data have emerged regarding these newly developed drugs. In fact, two medication classes have demonstrated cardiovascular protective effects, rapidly changing prescribing practices among diabetologists.
As a result, therapeutic recommendations have also evolved. Nowadays, not only changes in HbA1c levels are important (as a decrease reflects improved average blood glucose levels over the previous 6 weeks), but the prevention of severe, life-threatening complications has become an equally essential aspect of medical therapy.
Ten years ago, the kidneys were mainly considered target organs for diabetes-related complications. Today, it has been proven that one reason for elevated blood glucose levels is increased glucose reabsorption in the kidneys in diabetic patients, meaning the kidneys significantly contribute to hyperglycemia.
It was discovered that these new medications can inhibit this abnormal glucose reabsorption in the kidneys. As a result, not only do blood glucose levels decrease, but the body may also lose up to 280 kcal of energy daily, leading to weight loss. This corresponds to the energy expenditure achieved through approximately 25 minutes of jogging per day, which is particularly beneficial for the majority of overweight patients.
At the time of their introduction, there were concerns that the increased glucose excreted in the urine would lead to frequent urinary tract and genital infections, as glucose provides an ideal environment for pathogens. However, experience over recent years has shown that these risks can largely be prevented with increased attention and proper hygiene measures.
Fifteen years ago, insulin therapy was often the only option in the treatment of Type 2 Diabetes when oral medications failed to achieve adequate control. This approach had several disadvantages: patients often required multiple daily insulin injections, demanding significant knowledge, adaptation, and a stricter lifestyle because of the need to coordinate insulin administration with meals. Additionally, weight gain and the risk of hypoglycemia were common side effects.
The so-called SGLT2 inhibitors, which reduce the reabsorption of glucose and sodium in the kidneys, not only help lower blood glucose levels but also represent a more modern, metabolism-focused approach to the treatment of Type 2 Diabetes. Beyond improving blood sugar control, they have been proven to protect both the heart and the kidneys, often independently of their glucose-lowering effects. For this reason, current international guidelines strongly recommend these medications, especially in patients with heart failure or chronic kidney disease, even in some cases without diabetes.
Emerging research suggests that these medications may also positively affect cellular energy production, mitochondrial function, and metabolic communication between organs. This means their benefits may extend far beyond blood glucose reduction alone.
Currently, new therapeutic strategies are also being investigated, including combining SGLT2 inhibitors with other modern diabetes medications such as incretin-based therapies. Researchers are also developing compounds capable of blocking multiple glucose absorption pathways simultaneously, potentially leading to even greater metabolic, cardiovascular, and renal protective effects.
In the future, the goal is to make treatment even more personalized by identifying laboratory markers that can predict which patients will respond best to therapy, while also gaining a deeper understanding of long-term safety and organ-protective effects.
Digital healthcare technologies and continuous glucose monitoring systems (CGMS) may also help ensure that patients receive the most effective treatment possible. Since a rare but serious condition called ketoacidosis — which causes dangerous acidification of the blood — may occasionally occur even with normal blood glucose levels, careful monitoring is important when warning signs appear. In the future, continuous ketone monitoring may help enable earlier detection.
Overall, SGLT2 inhibitors have become one of the most important medication classes in personalized, modern diabetes care and are expected to form the foundation of many future therapeutic combinations.
Two members of our clinic’s team were also co-authors of a manuscript published in a highly prestigious and internationally recognized English-language scientific journal. The original article was published on April 27, 2026, in the journal Antioxidants and is available here:
The internists, endocrinologists, and cardiologists at Újszeged Egészségközpont treat patients with diabetes, heart failure, and chronic kidney disease based on the latest scientific evidence and the findings described above.
