KIU Publications

Cardiovascular and renal complications remained the leading causes of morbidity and mortality in type 2 diabetes, affecting approximately 537 million adults globally in 2021 with projections exceeding 783 million by 2045. Sodium-glucose cotransporter-2 (SGLT2) inhibitors transformed diabetes management by demonstrating robust cardiorenal protection beyond glycaemic control, yet optimal implementation strategies require precision approaches tailored to individual risk profiles. This narrative review synthesized current evidence on precision strategies for SGLT2 inhibitor use to optimize cardiovascular and renal outcomes in type 2 diabetes, evaluating patient selection, risk stratification, and implementation considerations. A systematic search of peer-reviewed literature, cardiovascular outcome trials, and guideline documents published from 2015 to 2026 informed this narrative synthesis. Meta-analytic data from 13 randomized trials encompassing 92,920 patients demonstrated that SGLT2 inhibitors reduce cardiovascular mortality by 12 percent, heart failure hospitalization by 29 percent, and renal composite endpoints by 35 percent. Benefits were consistent across baseline blood pressure, kidney function, and cardiovascular risk strata, with greatest absolute risk reductions in high-risk populations. SGLT2 inhibitors represented a cornerstone of precision diabetes care, offering substantial cardiorenal protection when strategically deployed according to individual risk profiles. Their integration into clinical practice requires early initiation, appropriate patient selection, and sustained therapy to maximize long-term benefits.