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.

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...

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 ...