Key result
Guideline-concordant SGLT2 inhibitor management reaches ~71% in patients with diabetes and HF or CKD.
Why the study?
Despite guideline recommendations and known cardiovascular and renal benefits, SGLT2 inhibitor use may remain suboptimal among eligible patients with T2DM and coexisting HF and/or CKD.
Observational (n=107)
No
Answers are grounded in this paper and cite their sources.
This clinical audit found that while 71.0% of patients with T2DM and coexisting HF or CKD had documented appropriate SGLT2 inhibitor management, 29.0% had indeterminate appropriateness primarily due to undocumented reasons for non-prescription, underscoring the need for improved clinical documentation and guideline adherence.
BackgroundSodium-glucose cotransporter-2 (SGLT2) inhibitors provide important cardiovascular and renal benefits in patients with type 2 diabetes mellitus (T2DM), particularly those with heart failure (HF) and/or chronic kidney disease (CKD).Despite guideline recommendations, their use may remain suboptimal in eligible patients. ObjectiveTo assess documented guideline-concordant SGLT2 inhibitor management among patients with T2DM and coexisting HF and/or CKD, using predefined audit criteria, and to identify documented reasons for nonprescription and compare management appropriateness across clinical categories. MethodsThis clinical audit was conducted at Surgimed Hospital, Lahore, from June 2024 to June 2025 and included 107 patients with T2DM and HF, CKD, or both.Eligibility for SGLT2 inhibitor therapy was assessed using predefined, guideline-based criteria.Demographic characteristics, comorbidities, glycated hemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), and current medications were recorded.SGLT2 inhibitor management was classified as appropriate use, documented appropriate non-use, or indeterminate prescribing appropriateness. ResultsThe mean age was 61.4 ± 10.8 years, and 62 (57.9%) patients were male.Overall, 69 (64.5%) patients were receiving SGLT2 inhibitors.Appropriate active treatment was documented in 67 (62.6%) patients, while nine (8.4%) had a documented valid reason for non-prescription.Indeterminate prescribing appropriateness was identified in 31 (29.0%)patients, comprising 29 (27.1%)non-users without documented justification and two (1.9%) patients receiving treatment whose prescribing appropriateness could not be verified.Overall, documented appropriate management was achieved in 76 patients (71.0%; 95% CI: 61.8-78.8%).Empagliflozin was the most frequently prescribed agent (63.8%).Among non-users, 29/38 (76.3%) had no documented reason for non-prescription. ConclusionsDocumented appropriate SGLT2 inhibitor management was achieved in 71.0% of patients.In the remaining 29.0%, prescribing appropriateness could not be established because of insufficient or unverifiable clinical documentation.These findings highlight the need for systematic identification of eligible patients, improved documentation of prescribing decisions, and clinician education to support guideline-concordant cardiorenal care.
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Khawar et al. (2026) conducted an observational in Type 2 diabetes mellitus with coexisting heart failure and/or chronic kidney disease (n=107). Sodium-glucose cotransporter-2 (SGLT2) inhibitors (empagliflozin or dapagliflozin) vs. Non-users of SGLT2 inhibitors was evaluated on Documented appropriate SGLT2 inhibitor management (appropriate active use or documented valid clinical reason for non-prescription) (95% CI 61.8-78.8). Documented guideline-concordant SGLT2 inhibitor management was achieved in 71.0% of patients with type 2 diabetes and heart failure or chronic kidney disease.
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