SGLT2 Inhibitors

Question 1

Name 2 SGLT2 Inhibitors.

Answer 1

1. Dapagliflozin

2. Empagliflozin

Question 2

What are the two indications of dapagliflozin as per Medication Profiler?

Answer 2

1. To help control blood sugar levels in diabetes

2. To help your heart work better when you have heart failure

Question 3

What does the “other important information” section on MedProfiler say about dapagliflozin?

Answer 3

Take ONCE daily at the same time each day. Can be taken with or without food. This medicine can cause dizziness in some people. Make sure that you and your friends and family know how to recognise and treat hypoglycaemia.

Question 4

Describe the role of SGLT2 inhibitors in patients with chronic kidney disease.

Answer 4

There is evidence to support the use of SGLT2 inhibitors in patients with chronic kidney disease (especially proteinuric) in patients with chronic kidney disease (regardless of whether they have diabetes or not)

Question 5

Describe the use of SGLT2 inhibitors in heart failure.

Answer 5

SGLT2 inhibitors have been shown to significantly reduce hospitalisations for heart failure in patients with or without diabetes. These effects appear to be independent of BGL control.

Question 6

Describe the effects of SGLT2 inhibitors on renal function.

Answer 6

Renal function declines relatively sharply in the initial phase of treatment with an SGLT2 inhibitor, however, after this, they preserve renal function so much so that the overall rate of decline in the long-term is less than with placebo.

Question 7

Describe the risk of hypoglycaemia with SGLT2 inhibitors.

Answer 7

SGLT2 inhibitors lower the threshold for the renal excretion of glucose, so if a patient’s sugars aren’t high they won’t fall, because the sugar won’t be excreted in the urine.

Question 8

What should be done with diuretics when a patient is starting an SGLT2 inhibitor?

Answer 8

Consider reducing/ceasing diuretics when patients start an SGLT2 inhibitor: especially when they are quite dry. Alternatively, in patients with high blood pressure/blood volume, there is less risk of volume depletion so you may not need to.

Question 9

Describe the role of SGLT2 inhibitors in HFrEF?

Answer 9

Patients should be treated with SGLT2 inhibitors in HFrEF (they will soon be the first-line management option).

Question 10

Patients with what level of renal function can be initiated on empagliflozin for heart failure?

Answer 10

Patients with CrCl >20 mL/min can be initiated on empagliflozin for heart failure (and continue treatment irrespective of future renal function)

Question 11

Patients with what level of renal function can be initiated on dapagliflozin for heart failure?

Answer 11

Patients with CrCl >30 mL/min can be initiated on dapagliflozin for heart failure (and continue treatment irrespective of future renal function)