The latest EASD consensus report reminds us that the goal of treatment for Type 2 Diabetes Mellitus (T2DM) is to prevent or delay complications.
In the UK, SGLT2is can only be initiated if the eGFR is ≥ 60 ml/min/1.73m2. For other medicines please consult SmPC for renal prescribing guidance. All products referenced are licensed for insufficiently controlled T2DM or improvement of glycaemic control in T2DM.
CKD or HF
- For patients with T2DM where Chronic Kidney Disease (CKD) or Heart Failure (HF) predominates, an SGLT2i* shown to reduce CKD and/or HF progression in CVOTs if eGFR is adequate**, is preferable. 1
- If SGLT2i not tolerated or contraindicated or if eGFR less than adequate add GLP-1 RA with proven CVD benefit*** 1
- For patients with T2DM where atherosclerotic cardiovascular disease (ASCVD) predominates, a GLP-1 RA with proven CVD benefit is preferable*** 1
- Or an SGLT2i with proven CVD benefit*** if eGFR is adequate** 1
*Empagliflozin, canagliflozin and dapagliflozin have shown reduction in HF and to reduce CKD progression in CVOTs.
**Be aware that SGLT2i labelling varies by region and individual agent with regard to indicated level of eGFR for initiation and continued use.
***Proven CVD benefit means it has label indication of reducing CVD events.
- NICE suggests that treatment with SGLT2is such as Invokana, may be appropriate for some adults with type 2 diabetes if metformin is contraindicated or not tolerated. 2
NICE also suggests SGLT2is, such as Invokana, as an option for dual therapy (i.e. at first intensification) for patients whose HbA1c rises to 58 mmol/mol (7.5%). 2
An SGLT2i, such as Invokana, can also be considered at second intensification as an add-on to other agents including metformin, sulphonylureas, thiazolidinediones, DPP4 inhibitors, GLP-1 agonists and insulin. 2
The Scottish Intercollegiate Guidelines Network (SIGN) recommends SGLT2is, such as Invokana, as add-on therapy to metformin, in addition to lifestyle measures, for patients with type 2 diabetes who do not achieve an HbA1c of <53 mmol/mol (7.2%) or individual target as agreed. 3
Why choose Invokana?
- Downey J. Pract Nurse. 2018; 48(1):12-16
- Neal B, et al. N Engl J Med. 2017; 377(7):644-57
- Silvio E, et al. Diabetologia. 2015; 58: 429-442
- Scirica B, et al. N Engl J Med. 2013; 369:1317-1326
- Rosenstock J, et al. JAMA. 2019; 321(1):69-79
- Marso S, et al. N Engl J Med. 2016; 375:1834-1844
- Green J, et al. N Engl J Med. 2015; 373:232-242
- White W, et al. N Engl J Med. 2013; 369:1327-1335
- Pfeffer M, et al. N Engl J Med. 2015; 373:2247-2257
- Marso S, et al. N Engl J Med. 2016; 375:311-322
- Holman R, et al. N Engl J Med. 2017; 377:1228-1239
- Dormandy J, et al. The Lancet. 2005; 366:1279-1289