SGLT2 Inhibitors in the Primary Health Care Setting: Consensus, Challenges, and Clinical Use

Sodium-glucose co-transporter 2 (SGLT2) inhibitors represent a major advancement in the pharmacological management oftype 2 diabetes mellitus (T2DM), with robust evidence demonstrating benefits beyond glycemic control. They offer additionalhealth benefits such as lowering the risk of heart failure hospitalizations, slowing chronic kidney disease (CKD) progression,and improving cardiovascular, renal, and metabolic health. The effective use of SGLT2 inhibitors also relies on comprehensivepatient education and counseling. Patients must understand the medication's benefits, such as reducing blood sugar andpreventing complications, and be instructed to stop the medication during acute illnesses or surgeries. It is vital to advice againstdiscontinuing use without medical guidance due to potential risks. Routine check-ups for clinical status, blood glucose, andkidney-heart function are essential for safety and effectiveness. However, the application of SGLT2 inhibitors in primary caresettings in rural India, specifically in Jharkhand, is low due to high costs, lack of provider awareness, insufficient monitoringsystems, and treatment hesitance. Furthermore, no peer-reviewed data is available to assess their use in this region. Hence, astructured questionnaire was created by expert groups and distributed to endocrinologists, cardiologists, and general physicians.Using the DELPHI methodology, consensus statements were formed based on evidence and reviewed by 12 experts from India.Statements that garnered over 65% agreement in discussions were included in the final consensus. The consensus emphasizedthat SGLT2 inhibitors benefit T2DM, heart failure, and CKD, with safe, structured use and integration into primary care beingkey to maximizing cardio-renal-metabolic outcomes.