Category: Federal Forum Posters
Purpose: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have been demonstrated to significantly reduce hemoglobin A1C and provide cardiovascular benefit in patients with diabetes. Additionally, they exhibit other favorable properties including weight loss and lowering blood pressure. Although clinical trials have shown that these medications are generally well-tolerated with low discontinuation rates, their side effect profile raises concern for potential failures in medication persistence in clinical practice. The purpose of this study is to evaluate efficacy, safety, and medication persistence of SGLT2 inhibitors at our military treatment facility.
Methods: Computerized outpatient prescription records were searched to identify SGLT2 inhibitor prescriptions dispensed between the dates of July 1, 2014 to July 31, 2017. The data was cross referenced to prescriber clinic location and medication therapy start date. Patients were excluded from this retrospective chart review if they were prescribed SGLT2 inhibitors prior to the start of the study period and if the prescription was written by a provider outside of the military treatment facility. A retrospective chart review of 119 patients was performed. Demographic data, baseline and follow-up data were collected to include: hemoglobin A1C, blood pressure, weight, concurrent anti-hyperglycemic medications, and documented side effects. This study received clearance for submission by the Public Affairs Officer/QI Review Board.
Results: A total of 119 patient charts were reviewed retrospectively. The baseline age ranged from 30 to 78 years with the median age of 58. Of the included patients, 82 patients were male, over 95 patients had diagnosis of hypertension and/or hyperlipidemia. The most commonly prescribed SGLT2 inhibitor was empagliflozin. More than half of the patients were prescribed these medications by a clinical pharmacist (69 patients) followed by endocrinologists (24 patients). This review showed hemoglobin A1C reduction of greater than 0.2 percent in 85 patients, greater than 5 mmHg reduction in systolic blood pressure in 60 patients, and weight loss of greater than 1kg in 82 patients. Medication persistence evaluation revealed that 71 patients continued with SGLT2 inhibitors as part of their medication therapy for diabetes; however, 48 patients discontinued use during the study period due to side effects, non-adherence, and lost to follow-up. Of the thirty-six patients that reported side effects including genitourinary infection and polyuria only 11 of them discontinued therapy due to intolerance.
Conclusion: The use of SGLT-2 inhibitors in the treatment of diabetes is on the rise due to the growing evidence of cardiovascular benefit in patients with diabetes. This retrospective chart review confirms the positive benefit of the SGLT2 inhibitors in lowering hemoglobin A1c, blood pressure and weight. Concern for medication persistence in clinical practice was also confirmed but was not solely attributed to side effects.
The views expressed in this abstract are those of the Authors and do not reflect the official policy of Department of the Army, Department of Defense, or the U.S. Government.
Sonya Babayan– Clinical Pharmacy Specialist, Veterans Affairs – Roseburg, Roseburg, OR