DIABETES MELLITUS-SGLT 2 INHIBITOR INDICATIONS

SUMMARY

1. Type 2 diabetes with established CVD or CKD and HBA1C >7% (maybe lower)

2. No relative contra-indications: genital thrush infections, recurrent UTIs, ketosis prone, ? frail elderly, prone to dehydration, immunocompromised, active foot ulcer

3. eGFR >30ml/min: maybe lower when more data available, glucose lowering efficacy is reduced with lower eGFR but BP lowering ,CV & renal benefits seem to be maintained

4. Warning: euglycaemic CKA can occur with SGLT2 inhibitors. Ketoacidosis occurs due to an absolute or relative lack of insulin. May be euglycaemic as glucose continues to be excreted by the kidneys.

5. Precipitants include: prolonged fasting, sepsis, reduction in insulin, significant alcohol intake, exercise

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].