Should the cardio‐protective properties of sodium‐glucose cotransporter 2 inhibitors dictate therapeutic decision‐making in patients with type 2 diabetes

Milder, Tamara Y.; Day, Richard O.; Stocker, Sophie L.; Greenfield, Jerry R.

doi:10.1111/imj.14819

Cited by 2 publications

(3 citation statements)

References 13 publications

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“…In addition, given the diverse patients seen in primary care, adherence to guidelines for every patient problem is hardly feasible [91]. Admittedly, especially with the SGLT2 inhibitors, nonspecialists are less confident in the use of these medications and worry about side-effects, lack of time for the necessary follow-up, or may view them more for non-kidney indications [92]. Clinicians may also hesitate because of unaffordability for patients.…”

Section: Contributors To the Gaps Between Knowledge And Implementatio...mentioning

confidence: 99%

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Luyckx,

Elmaghrabi,

Sahay

et al. 2023

Am J Nephrol

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Background: Chronic kidney disease (CKD) is an important but insufficiently recognized public health problem. Unprecedented advances in delaying progression of CKD and reducing kidney failure and death have been made in recent years, with the addition of the sodium glucose co-transporter 2 inhibitors and other newer medication to the established standard of care with inhibitors of the renin angiotensin system. Despite knowledge of these effective therapies, their prescription and use remains suboptimal globally, and more specially in low resource settings. Many challenges contribute to this gap between knowledge and translation into clinical care, which is even wider in lower resource settings across the globe. Implementation of guideline-directed care is hampered by lack of disease awareness, late or missed diagnosis, clinical inertia, poor quality care, cost of therapy, systemic biases, and lack of patient empowerment. All of these are exacerbated by the social determinants of health and global inequities. Summary CKD is a highly manageable condition but requires equitable and sustainable access to quality care supported by health policies, health financing, patient and healthcare worker education and affordability of medications and diagnostics. Key Messages The gap between the knowledge and tools to treat CKD and the implementation of optimal quality kidney care should no longer be tolerated. Advocacy, research and action are required to improve equitable access to sustainable quality care for CKD everywhere.

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Section: Contributors To the Gaps Between Knowledge And Implementatio...mentioning

confidence: 99%

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Luyckx,

Elmaghrabi,

Sahay

et al. 2023

Am J Nephrol

View full text Add to dashboard Cite

show abstract

“…1 Central to this revolution is the concept that the cardiovascular and renal benefits of SGLT2i are independent of the glucose-lowering effects of these drugs. [2][3][4][5] Dedicated heart failure and chronic kidney disease (CKD) outcome trials have established the role of SGLT2i for these conditions irrespective of the presence of diabetes. [6][7][8][9][10][11] Given the increasing prevalence of obesity, type 2 diabetes, heart failure and CKD, [12][13][14] SGLT2i have potential benefits for a considerable proportion of the adult community.…”

Section: Introductionmentioning

confidence: 99%

“…Since the results of the landmark EMPA‐REG OUTCOME study, there has been a revolution in our understanding of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) 1 . Central to this revolution is the concept that the cardiovascular and renal benefits of SGLT2i are independent of the glucose‐lowering effects of these drugs 2–5 . Dedicated heart failure and chronic kidney disease (CKD) outcome trials have established the role of SGLT2i for these conditions irrespective of the presence of diabetes 6–11 .…”

Section: Introductionmentioning

confidence: 99%

‘We are somehow fixated on this being a diabetes drug’: a qualitative study exploring the views of cardiologists and nephrologists about sodium‐glucose cotransporter 2 inhibitor initiation

Milder,

Stocker,

Baysari

et al. 2023

Internal Medicine Journal

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BackgroundSodium‐glucose cotransporter 2 inhibitors (SGLT2i) are now indicated for heart failure and chronic kidney disease (CKD), irrespective of the presence of diabetes. Hence, cardiologists and nephrologists have an important role in initiating these drugs.AimsTo explore cardiologists' and nephrologists' perspectives regarding initiating SGLT2i and their safety monitoring practices when initiating SGLT2i.MethodsPurposive and snowball approaches were used to recruit participants working in diverse areas in New South Wales, Australia. Semi‐structured interviews were conducted with 12 cardiologists and 12 nephrologists. Interviews were conducted until thematic saturation was reached. Emergent themes were identified from transcripts. An iterative general inductive approach was used for data analysis.ResultsThere was a reluctance amongst most non‐heart‐failure subspecialist cardiologists to initiate SGLT2i. Reasons included the perception of SGLT2i as diabetes drugs, concern about side effects, lack of experience and issues with follow‐up. In contrast, nephrologists reported feeling confident to initiate SGLT2i. Nephrologists varied in their opinions about the severity of CKD at which SGLT2i initiation was reasonable and monitoring of renal function following initiation. Government subsidisation was an important factor in the decision to prescribe SGLT2i to people without diabetes.ConclusionsOur findings highlight the complex transition from the perception of SGLT2i as diabetes drugs to cardiometabolic and reno‐protective agents. Interdisciplinary collaboration may enable greater confidence amongst specialists to initiate SGLT2i, including in patients with CKD. Additionally, there is a need for clear and detailed guidance about SGLT2i prescription in patients with renal dysfunction and renal function monitoring following SGLT2i initiation.

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Should the cardio‐protective properties of sodium‐glucose cotransporter 2 inhibitors dictate therapeutic decision‐making in patients with type 2 diabetes

Cited by 2 publications

References 13 publications

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

‘We are somehow fixated on this being a diabetes drug’: a qualitative study exploring the views of cardiologists and nephrologists about sodium‐glucose cotransporter 2 inhibitor initiation

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