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Clinical Considerations When Using SGLT-2 Inhibitors: Glycosuria interferes with the Determination of the Urine Albumin-to-Creatinine Ratio

Yoohung Hulandey

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors have become a valuable therapeutic option for managing type 2 diabetes mellitus. These drugs effectively lower blood glucose levels by increasing urinary glucose excretion. However, the presence of glycosuria, a consequence of SGLT-2 inhibitor use, can interfere with the accurate determination of the urine albumin-to-creatinine ratio (ACR), a widely used parameter for assessing kidney function. This interference arises from the competitive binding of glucose molecules to colorimetric indicators used in albumin measurement, leading to an underestimation of albumin levels. Additionally, SGLT-2 inhibitors can impact creatinine measurement by diluting urinary creatinine levels, potentially resulting in an overestimation of the ACR. To overcome these challenges, clinicians should consider confirmatory testing, perform ACR testing at optimal times, and explore alternative markers of kidney function, such as urinary cystatin C. Understanding these clinical considerations is crucial to ensure accurate assessment of renal health in patients receiving SGLT-2 inhibitors.