Compliance with SGLT2 Inhibitors Prescribing Guidelines in Diabetic Patients with ASCVD: Insights from Cath Lab

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M HANI1; M ABDOU2
1.Southampton University Hospital; 2. Queen Elizabeth Hospital Birmingham
Clinical Quality
CQ - Clinical Effectiveness
Cardiovascular

Abstract

Introduction:
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated significant benefits in reducing cardiovascular events in patients with type 2 diabetes and established coronary artery disease (CAD). Guidelines from the National Institute for Health and Care Excellence (NICE) and the European Society of Cardiology (ESC) recommend the use of SGLT2i in this high-risk population. This audit evaluates adherence to these guidelines, identifies barriers to compliance, and highlights areas for improvement.

Method:
A retrospective audit was conducted on diabetic patients with CAD who were managed from February 2024 to May 2024. Patient data were extracted from electronic health records, focusing on the prescription of SGLT2i, patient demographics, clinical outcomes, and reasons for non-compliance. Compliance was measured against the criteria outlined in NICE and ESC guidelines. Descriptive statistics and comparative analyses were performed.

Results:
Out of 171 patients whose invasive angiograms confirmed CAD, 59 (34.5%) met our inclusion criteria. Among these 59 patients, 12 (20.3%) were initiated on SGLT2i, 18 (30.5%) were already on SGLT2i therapy, and 29 (49.2%) were not prescribed SGLT2i.

Conclusions:
Despite their proven efficacy, there remains a gap in the initiation of SGLT2i in T2DM patients with evidence of CAD. This gap in compliance highlights the need for continued education and addressing barriers to optimize the use of SGLT2i in this population.

Comments

Thank you for sharing this insightful audit. It is striking that nearly half of eligible patients were not on SGLT2i despite guideline recommendations. This mirrors findings from our own audit, which also demonstrated under-prescription in a similar high-risk population. It highlights the ongoing need for clinician education and awareness to optimize guideline-directed therapy in these patients. 

Submitted by eirinaiostsiar… on

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 It’s very interesting to hear that your audit found similar results — it reinforces how widespread this issue is. I completely agree that continued clinician education and awareness are essential to improving uptake of SGLT2 inhibitors in high-risk patients. Hopefully, by sharing these findings collectively, we can drive more consistent implementation of guideline-directed therapy

Hi, thank you for sharing. It is a very meaningful finding. Would you mind sharing your exclusion criteria, in particular if you have any threshold for HbA1c higher limit, or for example previous DKA? Thank you! 

Submitted by hhchong17@gmail.com on

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In our audit, we included adult patients with type 2 diabetes and angiographically confirmed coronary artery disease who were under secondary care follow-up during the study period. 

We excluded patients with 

  • Type 1 diabetes
  • Age <18 years
  • eGFR below licensed threshold (severe CKD / dialysis)
  • Previous DKA
  • Pregnancy or breastfeeding
  • Hypersensitivity to SGLT2i
  • Other contraindications (e.g. recurrent severe infections, prior amputation with canagliflozin)
  • Incomplete or missing clinical data

We did not apply an upper HbA1c limit as an exclusion criterion.