Would you start an SGLT2 inhibitor in patients with diabetic kidney disease who also have a history of prior toe amputation?  

I would. I think the risk with SGLT2 and vascular disease is very low. Thus, I would give them if there are no other contraindications.

In most instances, amputations are preventable. Early in the progression of PAD, claudication is a symptom of it. In my experience, patients are not reluctant complaining about it. An arterial Doppler study of the patient’s legs’ arteries can provide crucial data to see if an angiogram ...

I will do a good physical, pulses, ABI, and vascular arterial studies looking for PAD as amputation can be due to different etiologies including infection, trauma, etc. Data for amputations with sglt2i from a large meta-analysis showed a very low risk and not significant vs placebo. This is why the ...

I would take a more nuanced approach. While CANA was the major SGLT2i that showed a major signal of increased risk of amputations, there were trends in other studies with the more mainstream formulations. If the patient has known advanced vascular disease and a prior amputation, I have leaned agains...