Steglatro (ertugliflozin) is an oral SGLT2 inhibitor approved by the FDA in December 2017 for type 2 diabetes. It lowers A1C by 0.7 to 1.0 percent, produces modest weight loss of 2 to 3 kg, and modestly reduces heart failure hospitalizations. The cardiovascular outcomes trial VERTIS CV met non-inferiority but did not show the broader MACE superiority seen with Jardiance, Farxiga, and Invokana — which is why Steglatro is typically a second-tier pick within the SGLT2 class.
What Steglatro Is
- Generic name: ertugliflozin
- Drug class: SGLT2 (sodium-glucose cotransporter 2) inhibitor
- Manufacturer: Merck and Pfizer co-promoted
- FDA approval: December 2017
- Forms: 5 mg and 15 mg tablets, taken once daily
- Combinations: Segluromet (ertugliflozin plus metformin), Steglujan (ertugliflozin plus sitagliptin)
How Steglatro Works
SGLT2 transporters in the kidney reabsorb most of the glucose filtered through the glomerulus. Steglatro blocks SGLT2, causing roughly 60 to 80 grams of glucose to spill into the urine each day. The downstream effects:
- Lower blood glucose without depending on insulin secretion
- Modest calorie loss of 240 to 320 kcal per day driving weight loss
- Mild osmotic diuresis lowering blood pressure 3 to 5 mmHg
- Reduced sodium reabsorption easing kidney workload
- Slight ketogenesis improving cardiac energy efficiency in heart failure
Approved Uses
- Type 2 diabetes — to improve glycemic control as an adjunct to diet and exercise
- Can be used as monotherapy when metformin is contraindicated or as add-on therapy
- Combination with metformin (Segluromet) or sitagliptin (Steglujan) for additive effect
Steglatro does not have FDA labels for heart failure or CKD specifically — those indications belong to Jardiance and Farxiga.
Dosing and Titration
| Setting | Dose | Notes |
|---|---|---|
| Starting dose | 5 mg once daily | Morning, with or without food |
| Maximum dose | 15 mg once daily | Increase if more glycemic effect needed |
| eGFR ≥ 45 | Full dose | Approved range |
| eGFR 30–44 | Not recommended | Limited benefit, more side effects |
| eGFR < 30 | Contraindicated | Discontinue |
| Hepatic impairment | Mild–moderate: full dose; severe: not recommended | No specific titration |
VERTIS CV — What the Trial Showed
VERTIS CV (Cannon et al., NEJM 2020) enrolled 8,246 patients with type 2 diabetes and established cardiovascular disease. Results:
- Primary endpoint (3-point MACE): non-inferior to placebo (HR 0.97), did NOT reach superiority
- Heart failure hospitalization: significantly reduced (HR 0.70)
- Cardiovascular death: no significant difference
- Renal composite (sustained eGFR decline, dialysis, renal death): no significant benefit
- Major safety signals: no amputation increase, no fracture increase, no DKA spike beyond class baseline
The takeaway: Steglatro is safe and modestly helps heart failure hospitalizations but lacks the broader cardiovascular and renal protection package that defines the rest of the class.
Benefits
- A1C reduction of 0.7 to 1.0 percent depending on dose and baseline
- Weight loss of 2 to 3 kg over 6 to 12 months
- Blood pressure reduction of 3 to 5 mmHg systolic
- Low hypoglycemia risk when used alone (under 4 percent)
- Heart failure hospitalization reduction (about 30 percent in VERTIS CV)
- Once-daily oral dosing
- Available in convenient combinations with metformin and sitagliptin
Common Side Effects
| Side Effect | Approximate Frequency |
|---|---|
| Genital yeast infection (women) | ~9% |
| Genital yeast infection (men) | ~4% |
| Urinary tract infection | 4–7% |
| Increased urination | ~3% |
| Thirst | ~2% |
| Headache | ~3% |
| Back pain | ~3% |
Rare but Serious Effects
- Euglycemic diabetic ketoacidosis — DKA with relatively normal glucose; triggered by illness, fasting, surgery, or very low-carb diets
- Fournier gangrene — very rare necrotizing infection of the perineum requiring emergency care
- Acute kidney injury — usually in dehydration or with ACE/ARB plus diuretic
- Volume depletion — dizziness, hypotension, particularly in older adults or those on diuretics
- Hyperkalemia — small rise in potassium
- Mild LDL cholesterol increase — typically 4 to 8 percent
Who Should Avoid Steglatro
- Type 1 diabetes (off-label, high DKA risk)
- History of DKA
- eGFR persistently below 30 mL/min
- End-stage renal disease or dialysis
- Severe hepatic impairment
- Active genitourinary infection until resolved
- Pregnancy and breastfeeding
Sick-Day Plan
- Hold Steglatro during vomiting, severe diarrhea, or fasting
- Stop at least 3 days before scheduled surgery (4 days for major surgery)
- Hold during any acute illness with reduced oral intake
- Resume only when eating and drinking are normal again
- Maintain hydration in heat, exercise, or low-carbohydrate eating
Steglatro Combinations
| Brand | Components | Notes |
|---|---|---|
| Steglatro | Ertugliflozin 5 or 15 mg | Single agent |
| Segluromet | Ertugliflozin + metformin | Twice daily |
| Steglujan | Ertugliflozin + sitagliptin 100 mg | Once daily, dual mechanism |
How Steglatro Compares With Other SGLT2 Inhibitors
| Drug | FDA Approval | MACE Superiority | HF Indication | CKD Indication |
|---|---|---|---|---|
| Jardiance (empagliflozin) | 2014 | Yes (EMPA-REG) | Yes | Yes |
| Farxiga (dapagliflozin) | 2014 | Yes (DECLARE) | Yes | Yes |
| Invokana (canagliflozin) | 2013 | Yes (CANVAS) | No | Yes |
| Steglatro (ertugliflozin) | 2017 | No (non-inferior) | No | No |
Monitoring on Steglatro
- eGFR and creatinine at baseline, 1 month, then every 3 to 6 months
- A1C every 3 months until stable
- Blood pressure, especially if also on antihypertensives
- Genitourinary symptoms reported promptly
- Volume status check at every visit (orthostatic dizziness, dry mucous membranes)
Practical Notes for Users
- Take in the morning to avoid nocturnal urination
- Drink water consistently — pale yellow urine is a good target
- Maintain genital hygiene; treat yeast infections early
- Carry sick-day rules: hold during illness, fasting, surgery
- Report any unusual fatigue, abdominal pain, or shortness of breath promptly — possible DKA
Related Reading
For class context see our SGLT2 inhibitors list, the broader SGLT2 side effects guide, and our comparison piece empagliflozin vs dapagliflozin. For background on lifestyle alongside drug therapy see diet and nutrition. External references: the VERTIS CV trial and the ADA Standards of Care.
The Bottom Line
Steglatro (ertugliflozin) is an effective SGLT2 inhibitor that lowers A1C by 0.7 to 1.0 percent, produces 2 to 3 kg of weight loss, and reduces heart failure hospitalizations. It met non-inferiority but not superiority for the broader MACE endpoint in VERTIS CV, and does not carry FDA indications for heart failure or CKD. Side effects mirror the class — yeast and urinary infections, dehydration, rare euglycemic DKA — without the amputation or fracture signal seen with Invokana. Most clinicians prefer Jardiance or Farxiga when cardiovascular or renal protection is the priority, and reserve Steglatro for cost-driven or formulary-driven choices or for users intolerant of other agents in the class.
