Off-label prescription of SGLT-2 inhibitors to patients with type 1 diabetes: an online survey of diabetes specialists in Italy

Scavini, Marina; Bertuzzi, Federico; Girelli, Angela; Celleno, Roberta; Molinari, Chiara; Tripodi, F.; Zanon, Milena Sira; Bartolo, Paolo Di; Penna, G. La

doi:10.1007/s00592-019-01386-7

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…Furthermore, a survey of 161 specialists regarding off-label use in Italy showed that 45% used SGLT2 inhibitors offlabel, but only some used International Consensus recommendations to reduce DKA risk, and two-thirds believed that ketosis required blood glucose levels .200 mg/dL (30).…”

Section: Barriers and Potential Solutionsmentioning

confidence: 99%

Comparison of Protocols to Reduce Diabetic Ketoacidosis in Patients With Type 1 Diabetes Prescribed a Sodium–Glucose Cotransporter 2 Inhibitor

Teng

Kurian

et al. 2021

Diabetes Spectrum

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OBJECTIVE | Sodium–glucose cotransporter 2 (SGLT2) inhibitors are approved for type 1 diabetes in Europe and Japan, with off-label use in type 1 diabetes in the United States. Although there were no consistent approaches to risk mitigation in clinical trials of these agents, protocols have been developed to try to reduce the risk of diabetic ketoacidosis (DKA). However, a validated risk mitigation strategy does not exist. We reviewed available DKA risk mitigation protocols to better understand the various strategies currently in use. METHODS | We conducted a search of the published medical literature and other medical information sources, including conference presentations, for protocols. We then categorized the information provided into guidance on patient selection, initiation of SGLT2 inhibitors, ketone monitoring, necessary patient action in the event of ketosis or DKA, and inpatient treatment of ketosis or DKA. RESULTS | Patient selection is generally similar among the protocols, although some require a minimum BMI and insulin dose. All protocols advocate routine measurement of ketones, although some insist on blood ketone tests. Although action steps for ketosis varies, all protocols advocate rapid patient intervention. The importance of evaluating ketones and acid-base balance even in the absence of hyperglycemia is emphasized by all protocols, as is the need to continue administering insulin until ketosis has resolved. CONCLUSION | DKA risk mitigation must be pursued systematically in individuals with type 1 diabetes, although the best strategy remains to be determined. Given the ongoing need for adjunctive therapies in type 1 diabetes and current use of SGLT2 inhibitors for this purpose, additional education and research are crucial, especially in the hospital environment, where DKA may not be diagnosed promptly and treated appropriately.

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Section: Barriers and Potential Solutionsmentioning

confidence: 99%

Comparison of Protocols to Reduce Diabetic Ketoacidosis in Patients With Type 1 Diabetes Prescribed a Sodium–Glucose Cotransporter 2 Inhibitor

Teng

Kurian

et al. 2021

Diabetes Spectrum

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“…4 The patterns and extent of off-label use of individual medicines and drug classes have been well documented in a range of settings and populations. 10,11 A variety of methodologies have been used including systematic reviews, online surveys and population-based prospective cohort studies. Patterns and predictors of off-label use of gabapentinoids have been examined using both prospective and retrospective, descriptive, cross-sectional study designs.…”

Section: Introductionmentioning

confidence: 99%

“…The patterns and extent of off‐label use of individual medicines and drug classes have been well documented in a range of settings and populations 10,11 . A variety of methodologies have been used including systematic reviews, online surveys and population‐based prospective cohort studies.…”

Section: Introductionmentioning

confidence: 99%

A snapshot of the prescribing patterns and off‐label use of gabapentinoid agents in tertiary care: a retrospective, cross‐sectional, descriptive study

Prior

2021

Pharmacy Practice and Res

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Background: Prescribing of gabapentinoids has increased worldwide and off-label use is well-described. Patients may be at risk of harm from inappropriate use. Prescribing patterns in tertiary care have not been described in the Australian setting. Aim: The aim of this study was to assess the prescribing patterns of gabapentinoids across a Local Health District in New South Wales, Australia. Method: Clinical and prescribing records over a 48-h period were reviewed. Patient demographics, renal function and concurrent opioid use were recorded. Dosing details and the indications for treatment were analysed. Results: Almost 40% of patients were prescribed concomitant opioid therapy, half of which were in the postoperative setting, an indication for which there is little evidence. Appropriate dose reductions were made in the majority of patients with renal impairment. Methods used for ceasing therapy were not in accordance with best practice. Indications for use were difficult to ascertain from medical records. However, only approximately half of usage of both agents appeared to be for approved indications. Conclusion: Prescribing of gabapentinoids could be improved. Although dosages are largely in accordance with recommended dosages for renal impairment, there is significant concern with concurrent use of opioids and use for non-approved indications, many of which lack clinical evidence. Further investigation into prescribing habits in the postoperative setting is warranted. There is a potential role for increased education and intervention to optimise use.

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Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes

Ehrmann

Kulzer

Roos

et al. 2020

The Lancet Diabetes & Endocrinology

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Off-label prescription of SGLT-2 inhibitors to patients with type 1 diabetes: an online survey of diabetes specialists in Italy

Cited by 3 publications

References 5 publications

Comparison of Protocols to Reduce Diabetic Ketoacidosis in Patients With Type 1 Diabetes Prescribed a Sodium–Glucose Cotransporter 2 Inhibitor

Comparison of Protocols to Reduce Diabetic Ketoacidosis in Patients With Type 1 Diabetes Prescribed a Sodium–Glucose Cotransporter 2 Inhibitor

A snapshot of the prescribing patterns and off‐label use of gabapentinoid agents in tertiary care: a retrospective, cross‐sectional, descriptive study

Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes

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