In patients with diabetes and GFR>60 mL/min/1.73 m2, SGLT2 inhibitors lower A1C by 0.5% to0.7%32; however, the glucose-lowering effect of SGLT2inhibition is reduced when GFR is <60 mL/min/1.73 m2; the riskof hypoglycemia in those on insulin or sulfonylurea therapy would thereforebe expected to be less clinically significant.85 In patients at riskof hypoglycemia, particularly those with A1C < 7% and taking insulinand/or sulfonylurea therapy, the insulin dose should be reduced byapproximately 20%, and/or sulfonylurea dose reduced or stopped at the timeof SGLT2 inhibitor initiation. This evidence concerns the gene INS and diabetes mellitus.