Introduction Individuals with type 2 diabetes mellitus (T2DM) and cardiovascular (CV) disease have very high CV risk. Recently, SGLT2 inhibitors (SGLT2i) in diabetic patients with heart failure (HF) have been shown to decrease mortality and recurrent hospital admissions. The ESC guidelines suggest using SGLT2i to lower risk of HF hospitalisation (class IA evidence). We ascertained whether appropriate patients with T2DM and HF, admitted to the hospital, were prescribed SGLT2i during the admission.
Methods We gathered data from consecutive patients diagnosed with HF and T2DM admitted to Lancashire Teaching Hospitals between March and September 2019. Patients with an eGFR <60mmol/mol were excluded (BNF recommendations). We also analysed patients with an eGFR between 45 and 59mmol/mol as the cut-off for SGLT2i prescription is imminently changing.
Results 132 patients (mean age 77 ±11 years, 75 males) were studied. The mean HbA1c was 58mmol/mol ± 19 with a median value of 52mmol/mol; median NT-ProBNP was 3802pg/mL. 27 patients (21%) met the criteria for SGLTi (eGFR ≥ 60) but none were prescribed the medication. Two patients were already on an SGLT2i. If the cut off dropped to 45mmol/mol, the number of eligible patients not receiving SGLT2i would rise to 55 (42%).
Conclusion A review of the current literature suggests that in eligible patients, HF re-admissions can be reduced by 35% using SGLT2i. In our study, 21% (eGFR ≥ 60) and 42% (eGFR ≥ 45) could have been prescribed an SGLT2i. We believe this is a missed opportunity during acute admissions. During such admissions, a patient may develop AKI, leading to a transient reduction of eGFR. Hence, we expect that the opportunity for prescribing SGLT2i may be larger than demonstrated in our study. We propose that the effectiveness of SGLT2i is further popularised through education amongst healthcare professionals involved in delivering HF services.
Conflict of Interest Nil
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