The protective effect of SGLT2 inhibition against
cardiovascular outcomes and death in our study is greater
than might be expected because of glucose lowering alone.
Findings from previous studies74 assessing the effects of
intensive glucose control have shown only slight effects on
these outcomes. Intensive glucose lowering has been
associated with an increased risk of cardiovascular death in
one trial,75 but not others,76–78 and the moderate reduction in
glycaemia achieved with SGLT2 inhibition,2 in the absence
of substantial increases in hypoglycaemia, would be
expected to provide some protection. The eff ฃects of SGLT2
inhibition on bodyweight are also slight2 and unlikely to
account for the cardiovascular and mortality benefi ts seen.