Consensus Article
SGLT2 Inhibitors in the Primary Health Care Setting: Consensus, Challenges, and Clinical Use
February 28, 2026 | Ajay Chhabra, Vk Dhandania, Sunil Mishra, Girish Parmar, Suneet Verma, Meenakshi Verma, Dk Singh, Jk Rath, Mk Bhadani, Pc Runnu, Jaikant Prasad, Akanksha Sonkar, Sanjay Kalra
Diabetes & Endocrinology
Sodium-glucose co-transporter 2 (SGLT2) inhibitors represent a major advancement in the pharmacological management of type 2 diabetes mellitus (T2DM), with robust evidence demonstrating benefits beyond glycemic control. They offer additional health benefits such as lowering the risk of heart failure hospitalizations, slowing chronic kidney disease (CKD) progression, and improving cardiovascular, renal, and metabolic health. The effective use of SGLT2 inhibitors also relies on comprehensive patient education and counseling. Patients must understand the medication's benefits, such as reducing blood sugar and preventing complications, and be instructed to stop the medication during acute illnesses or surgeries. It is vital to advice against discontinuing use without medical guidance due to potential risks. Routine check-ups for clinical status, blood glucose, and kidney-heart function are essential for safety and effectiveness. However, the application of SGLT2 inhibitors in primary care settings in rural India, specifically in Jharkhand, is low due to high costs, lack of provider awareness, insufficient monitoring systems, and treatment hesitance. Furthermore, no peer-reviewed data is available to assess their use in this region. Hence, a structured questionnaire was created by expert groups and distributed to endocrinologists, cardiologists, and general physicians. Using the DELPHI methodology, consensus statements were formed based on evidence and reviewed by 12 experts from India. Statements that garnered over 65% agreement in discussions were included in the final consensus. The consensus emphasized that SGLT2 inhibitors benefit T2DM, heart failure, and CKD, with safe, structured use and integration into primary care being key to maximizing cardiorenal-metabolic outcomes.