SGLT2 inhibitors and how we use them

In this podcast, Dr Rick Cutfield discusses the management of type two diabetes mellitus following the introduction of new funded medication in NZ.

He covers the importance of lifestyle, medication, and support at every step, and also the pharmacological management including the new stepwise approach to management.

Indications and precautions of the new classes of subsidised medications: Sodium glucose co-transporter 2 (SGLT-2) inhibitors, and briefly Glucagon like peptide-1 receptor (GLP-1) agonists are also covered.

Topics

Lifestyle interventions
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Updated guidelines
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UTIs
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Monitoring
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HbA1c maximum drop
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Reducing hospitalisations
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Diabetes in NZ going forward
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Health equity
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Take-home messages
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Take home messages

Stick with lifestyle changes.
Continue to use metformin safely. Think about using dual agents.
Don’t forget about insulin, but we will be using it far less.
Think of diabetes as a condition where heart disease and kidney disease is to be absolutely prevented.
Think about cancer screening.
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Resources

Optimising pharmacological management of HbA1c levels in patients with type 2 diabetes: from metformin to insulin bpacnz (2019)
Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure NEJM (2020)
Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes NEJM (2016)
Empagliflozin Reduces Blood Pressure in Patients With Type 2 Diabetes and Hypertension Diabetes Care (2015)
Proposal to fund two new medicines for type 2 diabetes Pharmac (2020)
Type 2 Diabetes Management Guidance MOH/NZSSD (2020)

Presenter

Dr Rick Cutfield

Endocrinologist

Dr Rick Cutfield is the Clinical Director of the Endocrinology & Diabetes Division at Waitemata DHB. He is active in teaching, clinical research and all aspects of diabetes, endocrinology and general medicine.