Sodium-glucose linked transporter type 2 (SGLT2) inhibitors are a relatively new 
class of antidiabetic drugs with positive cardiovascular and kidney effects. The 
aim of this review is to present the safety issues associated with SGLT2 
inhibitors. Urogenital infections are the most frequently encountered adverse 
events, although tend to be mild to moderate and are easily manageable with 
standard treatment. Although no increased acute kidney injury risk was evident 
in the major trials, the mechanism of action of these drugs requires caution 
when they are administered in patients with extracellular volume depletion or 
with drugs affecting renal hemodynamics. Canagliflozin raised the risk of 
amputations and the rate of fractures in the CANVAS trial, although more data 
are necessary before drawing definite conclusions. The risk of euglycemic 
diabetic ketoacidosis seems to be minimal when the drugs are prescribed 
properly. Regarding other adverse events, SGLT2 inhibitors do not increase the 
risk of hypoglycemia even when co-administered with insulin, but a decrease in 
the dose of sulphonylureas may be needed. The available data do not point to a 
causative role of SGLT2 inhibitors on malignancy risk, however, these drugs 
should be used with caution in patients with known hematuria or history of 
bladder cancer. SGLT2 inhibitors seem to be safe and effective in the treatment 
of diabetes but more studies are required to assess their long-term safety.