Wider use of SGLT2 inhibitors for CVD recommended by NICE

pharmafile | September 7, 2021 | News story | Manufacturing and Production, Medical Communications  

NICE has updated its guidelines on the management of type 2 diabetes, recommending wider use of SGLT2 inhibitors in those with or at high-risk of cardiovascular disease (CVD).

The guidance is out for consultation until 14 October and recommends offering an SGLT2 inhibitor in addition to metformin in patients with diabetes who have congestive heart failure or established cardiovascular disease.

For those at high risk of CVD, an SGLT2 inhibitor should be considered alongside first-line treatment with metformin, the recommendations state.

The guidance recommends that this dual therapy should be done sequentially, starting with metformin, to check tolerability to the drugs, the guidelines state.

When metformin is contraindicated or is not tolerated in those with or at high risk of cardiovascular disease, an SGLT2 inhibitor can be given on its own, under the new guidance for 2021.

Diabetic patients who cannot take metformin and are not at high risk of CVD, should be considered for a DPP-4 inhibitor, pioglitazone, a sulfonylurea or an SGLT2 inhibitor if it meets criteria previously set out by NICE in its technology appraisal on the drugs.

Speaking to Pulse, Dr Becky Haines, a clinical lead for diabetes at NHS Newcastle Gateshead CCG, said: “The main pharmacological change is the early addition of SGLT2i alongside Metformin if tolerated, for people with congestive heart failure, atherosclerotic CV disease or at high risk of CV disease. And with “high risk” being QRisk2 over 10% I would expect this to be a large number of people with T2DM.

“Using these two drugs together for first line pharmacological therapy in this way will be a new way of working for most people in primary care, although some specialist GPs and nurses are already following the evidence and using this approach.

“We need to see what people with T2DM feel about another tablet – bearing in mind they may also be offered a statin and possibly BP lowering medication at the same time – the burden of multiple medications should not be underestimated and may be one of the limiting factors.”

Kat Jenkins

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