NICE Calls for Wider Use of SGLT2 Inhibitors As First-line Diabetes Treatment

Dawn O'Shea

September 10, 2021

New draft guidelines from The National Institute for Health and Care Excellence (NICE) recommend wider use of SGLT2 inhibitors in the first-line treatment of diabetes in adults.

The guideline recommends that an SGLT2 inhibitor should be added to metformin in the first-line treatment of diabetes in patients with congestive heart failure (CHF) or established atherosclerotic disease. The addition of an SGLT2 can also be considered for patients at high risk of developing cardiovascular disease (CVD).

When starting dual therapy with metformin and an SGLT2 inhibitor as first-line therapy, it is recommended that the treatments be started sequentially, starting with metformin.

For people with CHF or established atherosclerotic CVD for whom metformin is contraindicated or not tolerated, SGLT2 inhibitor monotherapy is recommended, and this can also be considered for people at high risk of developing CVD.

For patients who do not meet these criteria, first-line treatment with a DPP-4 inhibitor, pioglitazone, a sulfonylurea or an SGLT2 inhibitor can be considered if they meet the requirements set out in NICE guidance on canagliflozin, dapagliflozin and empagliflozin as monotherapies for type 2 diabetes and ertugliflozin as monotherapy, or with metformin.

The new guidance cautions that SGLT2 inhibitors should not be used in people who are following a very low carbohydrate or ketogenic diet, as this can lead to diabetic ketoacidosis (DKA).

For patients who are pregnant, planning a pregnancy or breastfeeding, advice on contraception and family planning should be offered.

NICE also advises that renal function requires careful monitoring as SGLT2 inhibitors can cause fluid volume depletion and have an adverse effect on renal function.

The draft guidance is open for consultation until 14 October. The final recommendations are expected to be published in February 2022.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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