Guidelines presents Primary Care Hacks, a series of clinical aide-memoires across a range of topics. Developed by Dr Kevin Fernando, Primary Care Hacks aim to provide a quick and easy resource for primary healthcare professionals and ultimately help improve patients' lives.
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Extra-Glycaemic Indications of SGLT2 Inhibitors
SGLT2 inhibitors are now the standard of care for the majority of people living with type 2 diabetes as preferred add-on therapy to metformin. SGLT2 inhibitors are now also being used in people without type 2 diabetes; however, currently available SGLT2 inhibitors have different licensed indications as well as estimated glomerular filtration rate (eGFR) thresholds for use. This makes life potentially confusing for primary healthcare professionals.
This Primary Care Hack summarises the extra-glycaemic indications of currently available SGLT2 inhibitors, to allow you to prescribe these drugs safely and appropriately in primary care.
Latest UpdatesSeptember 2023:
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Expand the table for full view. Find a downloadable PDF of the table at the end of the article.
| SGLT2 | Indication | CKD Stage (ml/min/1.73 m2) | ||||
|---|---|---|---|---|---|---|
| Stages G1 and G2 eGFR ≥60 | Stage G3a eGFR 45–49 | Stage G3b eGFR 30–44 | Stage G4 eGFR 15–30 | Stage G5 eGFR <15 | ||
| Canagliflozin | Treatment of diabetic kidney disease in adults with T2D as add-on to standard of care | Initiate or continue 100 mg | If urinary ACR ≥30 mg/mmol, continue 100 mg and continue dosing until dialysis or renal transplantation Do not initiate if eGFR <30 | |||
| Dapagliflozin | Treatment of symptomatic chronic heart failure regardless of ejection fraction (HFrEF and HFpEF) in adults with or without T2D | Initiate or continue 10 mg | No dose adjustment is required based on renal function It is not recommended to initiate if eGFR <15 | |||
| Treatment of CKD in adults with or without T2D | ||||||
| Empagliflozin | Treatment of symptomatic chronic heart failure regardless of ejection fraction (HFrEF and HFpEF) in adults with or without T2D | Initiate or continue 10 mg | Continue 10 mg in patients already started but due to limited experience, it is not recommended to initiate if eGFR <20 | |||
| Treatment of CKD in adults with or without T2D | ||||||
Notes:
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| ACR=albumin/creatinine ration; CKD=chronic kidney disease; eGFR=estimated glomerular filtration rate; HFpEF=heart failure with preserved injection fraction; HFrEF=heart failure with reduced ejection fraction; NICE TA=NICE technology appraisal; SGLT2=sodium–glucose cotransporter 2; SMC=Scottish Medicines Consortium; T1D=type 1 diabetes; T2D=type 2 diabetes. | ||||||
Extra-Glycaemic Indication of SGLT2 Inhibitors
| Primary Care Hacks are developed by Dr Kevin Fernando, GP Partner, North Berwick Health Centre; GP with special interest in CVRM and medical education; Content Advisor for WebMD Medscape Global and UK. This Primary Care Hack is based on the author's interpretation of relevant summaries of product characteristics. Primary Care Hacks are for information for primary healthcare professionals in the UK only. They bring together currently available recommendations and/or prescribing information and indications for therapeutics licensed within Great Britain. Licensed indications and/or prescribing information for Northern Ireland may differ. You are advised to review local licensed indications before prescribing any therapeutic. Primary Care Hacks are reviewed intermittently to ensure the information is up to date at the time of publication. Primary Care Hacks are independently produced by WebMD, LLC and have not been created in conjunction with any guideline or prescribing body. |
Erratum, October 2023: An earlier version of this Primary Care Hack incorrectly stated dosing for dapagliflozin and empagliflozin at 100 mg. This has now been corrected to 10 mg.