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A bductive reasoning is an unconventional approach to understanding medical science. It can be described as the opposite of the usual ‘bench-to-bedside’ technique, whereby one applies laboratory-based learning to the treatment of patients. Abductive reasoning reverses this process and applies the observation of unexpected outcomes of therapy in order to further understand the pathophysiology of disease, a ‘bedside-to-bench’ learning approach. SGLT2 inhibitors act directly on the kidneys, and have demonstrated various unexpected clinical outcomes in T2DM. These agents act as a unifying intervention to improve the macrovascular, microvascular, and metabolic outcomes in T2DM. Observations in SGLT2-inhibitor therapy provide opportunities to revisit the possible role of the kidneys in the pathogenesis of metabolic syndrome. Albuminuria is a unifying marker for kidney disease, and vasculo-metabolic dysfunction. Based on observations with SGLT2 inhibitors, we apply abductive reasoning to emphasize the pathological role of the kidneys in metabolic syndrome. Further, we support the proposition of including albuminuria as a key parameter in the definition of metabolic syndrome.

Vasculo-metabolic Axis in Type 2 Diabetes Mellitus—Abductive Reasoning from Sodium-glucose Cotransporter 2-inhibitor Evidence