Use of SGLT2 inhibitors in primary care | ACROSS T2D

Use of SGLT2 inhibitors in primary care

This module outlines SGLT2 inhibitor CVOT data, safety information and practical guidance for primary care physicians treating patients with T2D, cardiovascular and/or kidney disease.

Use of SGLT2 inhibitors in primary care

Use of SGLT2 inhibitors in primary care
Use of SGLT2 inhibitors in primary care
Use of SGLT2 inhibitors in primary care
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CV and kidney disease are major contributors to the burden of T2D
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Life expectancy is reduced in patients with diabetes and CV disease or CKD
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Patients with T2D who have had an MI or stroke have a higher risk of death
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Diabetes is associated with a higher risk of HF
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Patients with HF and T2D have reduced survival
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Worsening kidney disease is associated with higher mortality
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Patients with CKD are likely to also have CV disease
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Use of SGLT2 inhibitors in primary care
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Multifactorial management of CV risk factors is well established as standard of care for patients with T2D
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CV risk factors are not at target in many patients with T2D
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SGLT2 inhibitors have been shown to improve CV risk factors in patients with T2D
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Reductions in CV, HF and kidney outcomes observed with SGLT2 inhibitors in patients with T2D
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Treatment with empagliflozin is associated with increased life expectancy compared with placebo
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Effects of SGLT2 inhibitors on the cardio-renal-metabolic systems may be mediated via multiple mechanisms
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Use of SGLT2 inhibitors in primary care
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A holistic approach to T2D care addresses the cardiovascular, renal and metabolic aspects of disease
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Since 2016, societies have been recommending the use of SGLT2 inhibitors and/or GLP-1 receptor agonists for their cardio-renal-metabolic benefits
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Diabetes societies recommend that the choice of second-line therapy should be based on assessment of established ASCVD, HF or CKD
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Primary Care Diabetes Europe recommends stratifying patients with T2D based on levels of CV risk
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Primary Care Diabetes Europe recommends SGLT2 inhibitors for patients with T2D at very high CV risk
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Primary Care Diabetes Europe recommends SGLT2 inhibitors for patients with T2D at high CV risk, including patients who are overweight/obese
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Use of SGLT2 inhibitors in primary care
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The safety profile of SGLT2 inhibitors is well established
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In rare cases, serious events may occur with SGLT2 inhibitors
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Dosing and administration guidance should be given to patients when initiating an SGLT2 inhibitor
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Kidney function should be considered when initiating an SGLT2 inhibitor
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Volume intake and eGFR should be monitored when initiating patients on SGLT2 inhibitors
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An initial dip in eGFR may occur upon treatment with SGLT2 inhibitors, with subsequent stabilisation
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In periods of acute illness, all patients should follow “sick-day” rules to minimise risk of complications (1)
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In periods of acute illness, all patients should follow “sick-day” rules to minimise risk of complications (2)
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In periods of acute illness, all patients should follow “sick‑day” rules to minimise risk of complications (3)
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Stepwise approach to prescription of SGLT2 inhibitors
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Addressing the systemic effects of T2D should be a core objective of patient management
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SGLT2 inhibitors in the management of patients with T2D: benefit–risk assessment
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Back-up slides
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PCDE recommends SGLT2 inhibitors for patients with T2D at very high CV risk
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PCDE recommends SGLT2 inhibitors for patients with T2D at high CV risk, including patients who are overweight/obese