SGLT2 inhibitors: here we go again?

Jain and colleagues explore screening for use of SGLT2 inhibitors to ameliorate the emergence of progressive chronic kidney disease and its comorbidities.1This is a manifestation of renal medicine’s strategic shift in focus from palliation towards prevention. It is a conundrum in the now traditional terms of evidence based medicine—efficacy, efficiency, and effectiveness. Of course, the deferment of pathology is not its eradication, as shown over decades by statins. To the three Es must be added the possible extra, collateral hazards of treatment, as discussed in letters in the same issue of The BMJ for statins and diabetes.23Leaving aside just what the shorthand of a multi-staged “chronic kidney disease” is being used to represent, it seems relevant to remind this generation of nephrologists that following US prompted clinical science proved uncomfortable in the past—when the National Institute for Health and Care Excellence, Cochrane, and medicines agencies offered no barrier of scepticism…
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