Type 2: Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors (Flozins)

Question 1

What are they all associated with

Answer 1

DKA

Question 2

What is the updated guidance for their use in cardiovascular patients?

Answer 2

NICE now recommends offering an SGLT2 inhibitor with proven cardiovascular benefit in addition to metformin first-line in patients with type 2 diabetes and chronic heart failure or established atherosclerotic cardiovascular disease. Adding an SGLT2 inhibitor to metformin therapy should also be considered in patients at high-risk of developing cardiovascular disease (10-year risk of more than 10% using QRISK2 in those aged ≥40 years, or the presence of one or more cardiovascular risk factors in those aged <40 years)

Question 3

MOA

Answer 3

Reversibly inhibit sodium- glucose - co-transporter 2 in renal proximal convulated tubule to reduce glucose reabsorption and increase urinary glucose excretion

Question 4

What is canagliflozin associated with

Answer 4

Increased risk of lower limb amputation (mainly toes)

Question 5

What is the egfr for dapagliflozin?

Answer 5

Avoid if egfr is <15ml/min

Question 6

What do with the doses of insulins and sulphonylureas when given with flozins

Answer 6

May need to reduce dose of these when given with flozins

Question 7

Side effects

Answer 7

Weight loss, DKA, increased infection risk, urinary disorders

Question 8

What are the black triangle drugs

Answer 8

CANAGLIFLOZIN, dapagliflozin, empagliflozin,

Question 9

MHRA advice on dapagliflozin

Answer 9

Forxiga® (dapagliflozin) 5 mg should no longer be used for the treatment of Type 1 Diabetes Mellitus