Aim: After almost 2 centuries, SGLT2-i have made their comeback in human pharmacology through successful re-introduction in diabetes type 2 (T2D). Via restriction of renal glucose reabsorption, SGLT2-i have shown promising results. The aim of this audit was to ensure that current practice at UHCW NHS Trust is in line with the agreed national standards, whilst collecting clinical data from the use of SGLT2-i.
Methods: This retrospective audit compared the use of all licenced SGLT2-I at UHCW NHS Trust. Data from 75 patients who received SGLT2-i through hospital-issued prescriptions from Jan.2014Oct.2016 was collected. Medical notes and electronic files were examined for demographics, glycaemic and non-glycaemic cardiovascular outcomes, side effects and possible prescribing errors.
Results: Dapagliflozin was most commonly used till the published EMPA-REG outcome study in 2015, after which empagliflozin took its place. As far as timing of prescription is concerned, their addition appears to be late in T2D, most probably due to their recent approval. Our data show higher efficacy of canagliflozin in HbA1c reduction and better trend in BMI control. Urinary tract infections and thrush were one-off events, only 1 patient developed a new foot ulcer, urinary albumin excretion was improved, lipids were unaffected, there was no evidence of bone density reduction and liver function was most often improved or unaffected. With regards to prescription errors, 2 of the prescriptions were unlicensed for T1DM and 5 of the patients did not have normal baseline eGFR. Moreover, 5 of the patients were not started at the recommended dose.
Conclusions: In our sample, canagliflozin induced better glycaemic control and the effects on renal preservation were promising. SGLT2-i were safe in use but regular monitoring of their multi-systematic effects is essential. Prescribing errors can be avoided through staff re-education so that good quality of care is maintained.