6 responses to “SGLT2i in patients with diabetes: translating an evolving body of evidence to the nuances of practice”

  1. Thanks for this comprehensive review.

  2. This review is absolutely outstanding and helpful. REAL numbers with which to engage in shared decisions. And presented with healthy skepticism.

  3. Great review. Although risks of euglycemic DKA and importance of sick day teaching and hydration not mentioned. While drug companies will argue that euglycemic DKA is rare, I have seen enough patients presenting to ER to see it differently.

  4. A very helpful summary

  5. It might also be of interest to know that through the application of “therapeutic carbohydrate restriction,” there is evidence that low-carbohydrate patterns of eating can result in the same positive benefits of an SGLT2i prescription. Many Canadian patients have been successfully putting their diabetes into remission using this approach. While it is recognized that not every patient would be willing to make the lifestyle changes required to achieve these results, it is equally important equally to note that there will be a group of patients who are motivated to make these lifestyle changes if healthcare practitioners were willing to also discuss this option with their patients.

    Here is an article that discusses how certain eating patterns can provide the similar benefits to an SGLT2i: “The “discordant doppelganger dilemma”: SGLT2i mimics therapeutic carbohydrate restriction – food choice first over pharma?” available at https://www.nature.com/articles/s41371-021-00482-y

    And here is a new website for patients and clinicians on diabetes remission – several testimonials exist of patients successfully using lifestyle changes such as changing how they eat to achieve remission of their diabetes: https://www.diabetesremission.ca/

  6. Adding this note for BC clinicians and patients,
    DAPAGLIFLOZIN is a REGULAR BENEFIT drug in BC and does not require a special authority for any indication.
    It is also available as a generic drug now which reduces drug cost substantially and is less costly then splitting an empagliflozin tablet.
    Thank you for the summary Jamie,
    Cait O’Sullivan, PharmD

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