Diabetes Ther. 2026 Aug 29. doi: 10.1007/s13300-026-01913-0. Online ahead of print.
ABSTRACT
INTRODUCTION: Prediabetes is a metabolic state that frequently precedes overt type 2 diabetes mellitus (T2DM) and is associated with an increased risk of micro- and macrovascular complications. Lifestyle modification remains the cornerstone of management, and several pharmacological agents, including metformin, pioglitazone, acarbose and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), have demonstrated efficacy in delaying progression to T2DM. Sodium-glucose cotransporter 2 (SGLT2) inhibitors (often referred to as gliflozins) are increasingly being investigated in this context. The aim of this review is to summarise current evidence regarding the use of SGLT2 inhibitors in adults with prediabetes and to discuss the arguments for and against their routine clinical use.
METHODS: A narrative review of publications retrieved from the PubMed database, addressing the role of SGLT2 inhibitors in prediabetes, was performed. Original studies, meta-analyses, systematic reviews and high-quality narrative reviews up to February 2026 were considered for inclusion.
RESULTS: Multiple studies have demonstrated that SGLT2 inhibitors improve insulin sensitivity, promote modest weight reduction, lower blood pressure and exert favourable effects on hepatic lipid metabolism. Two contemporary meta-analyses confirm that SGLT2 inhibitors reduce the incidence of new-onset T2DM in adults with prediabetes who also have heart failure or chronic kidney disease (CKD), with relative risk reductions of approximately 19-21%. This drug class is generally well tolerated, although it is associated with increased risk of genitourinary infections and rare but serious euglycaemic diabetic ketoacidosis.
CONCLUSIONS: SGLT2 inhibitors appear to be a promising class of drugs for the prevention of T2DM, particularly in high-risk populations with concomitant cardiovascular or renal disease. However, dedicated randomised controlled trials in prediabetes-with adequate follow-up and washout periods-are necessary before routine use can be recommended. Current 2026 guidelines do not yet endorse SGLT2 inhibitors as a preventive therapy for prediabetes outside the indications of heart failure and CKD.
PMID:42667546 | DOI:10.1007/s13300-026-01913-0