SGLT2 inhibitors in type 2 diabetes: a comprehensive review of their effects on the autonomic nervous system and cardiovascular health.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are antidiabetic drugs that help lower high blood sugar levels by blocking the reabsorption of glucose in the kidneys. Although their primary function is to control blood sugar in type 2 diabetes mellitus (T2DM), growing evidence suggests they may also have additional benefits, particularly in reducing neurological and cardiovascular complications related to T2DM. This study explores the neuroprotective effects of SGLT2i, which appear to improve symptoms of peripheral neuropathy by enhancing nerve conduction for both sensory and motor functions and reducing neuropathic pain. These effects are believed to occur through mechanisms such as the activation of AMP-activated protein kinase and the reduction of mitogen-activated protein kinase phosphorylation, both of which protect nerve function. In terms of cardiovascular health, SGLT2i show cardioprotective effects by lowering sympathetic nervous system activity, reducing blood pressure, and minimizing the risk of heart failure-related hospitalizations and arrhythmias. Furthermore, these inhibitors may play a role in preventing diabetic retinopathy by reducing oxidative stress and blocking inflammatory pathways in retinal tissue. Although some research has hinted at a potential link between SGLT2i use and increased risk of diabetic foot complications, the results are not definitive and require further study. Overall, SGLT2 inhibitors represent a multifaceted approach in managing T2DM, offering additional neurological and cardiovascular benefits. Ongoing research is critical to fully understand their mechanisms, enhance therapeutic outcomes, and confirm their safety for a wide range of patients.