Ertugliflozin

How it works

It blocks SGLT2 in the proximal renal tubule, reducing glucose reabsorption and increasing urinary glucose excretion in a manner independent of insulin.

Prescribing in practice

• It can precipitate diabetic ketoacidosis, sometimes with near-normal blood glucose, so it should be stopped during acute illness, before major surgery and if ketoacidosis is suspected.
• There is an increased risk of genital and urinary tract infection and, rarely, of Fournier's gangrene of the perineum, which requires urgent assessment.
• Volume depletion and hypotension can occur, particularly in older patients or those on diuretics, and glycaemic efficacy falls with declining renal function.

Monitoring

Monitor renal function, hydration and volume status, and remain alert for genitourinary infection and ketoacidosis.

Counselling the patient

• Learn the warning signs of ketoacidosis and seek urgent help if unwell, even if glucose readings are not high.
• Maintain good genital hygiene and report symptoms of infection or severe perineal pain, swelling or redness.
• Stay hydrated and follow sick-day advice about pausing the medicine during acute illness.

Evidence & guidelines

The VERTIS CV cardiovascular outcome trial established the cardiovascular safety profile of ertugliflozin in type 2 diabetes.