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A cardiologist from Brigham and Women's Hospital discusses prescribing SGLT2 inhibitors to patients already receiving or with an indication for diuretics or RAAS inhibitors.
Finding the appropriate treatment algorithm and management strategy for patients with diabetes or other chronic conditions is always a challenge. While new agents have created opportunities for optimal disease management, identifying effective agents for addition into treatment algorithms poses a set of challenges.
Within the past few years, many clinicians have been accepted the challenge of fitting SGLT2 inhibitors into the management strategy of their patients. Now, this group of clinicians is expected to grow even larger as more organizations recommend use of the agents and more trials support their safety and efficacy profiles.
While SGLT2 inhibitors have demonstrated both renal and cardiovascular benefit, the recency associated with the newer indications leaves many clinicians with questions they feel may not have been addressed in clinical trials. An example of this is prescribing alongside diuretics. Among patients with heart failure or chronic kidney disease diagnoses, use of diuretics is common, which raises concern for many considering an SGLT2 inhibitor due to its diuretic effects.
For more perspective, Practical Cardiology invited Muthiah Vaduganathan, MD, MPH, who recently helped write a scientific statement from the American Heart Association on the cardiorenal benefits of the class, to take part in an interview on the topic.