The updated guideline now includes text on sodium–glucose cotransporter 2 (SGLT-2) inhibitors in the section on initial drug treatment. Additionally, new information on SGLT-2 inhibitors was added to the box on action to take if metformin is contraindicated or not tolerated.
Canagliflozin may increase the risk of lower-limb amputation (mainly toes) in patients with type 2 diabetes. Evidence does not show an increased risk for dapagliflozin and empagliflozin, but the risk may be a class effect. Preventive foot care is important for all patients with diabetes.