How blocking the transporter lowers glucose
SGLT2 (sodium glucose cotransporter 2) sits in the proximal tubule of the kidney and reclaims most of the glucose filtered from the blood. SGLT2 inhibitors block this transporter, so more glucose is excreted in the urine and blood glucose falls. Because the effect depends on filtered glucose rather than insulin, the risk of low blood sugar from the drug alone is relatively low.
The accompanying loss of glucose and sodium also produces a mild diuretic effect.
Benefits that reach beyond blood sugar
Large trials found that these agents reduce heart failure hospitalizations and slow progression of chronic kidney disease, including in some people without diabetes. The mechanisms are still being studied and are thought to involve effects on cardiac and kidney workload rather than glucose lowering alone.
These drugs carry specific considerations, such as risk of genital infections and rare ketoacidosis, so they must be prescribed and monitored by a clinician. General educational information, not medical advice.