Primary care is suited to this type of research because this is where the majority of people with type 2 diabetes are managed. The network represents approximately 10% of primary care practices in England and Wales. There are over 1500 practices within the network, which includes a representative sample of over 10 million registered patients. The RCGP RSC has been supported by the Department of Health for over 50 years and produces a weekly report to monitor the trends of respiratory diseases including influenza. The RCGP RSC is a sentinel network made up of volunteer primary care practices distributed throughout England and parts of Wales. Co-prescribing of SGLT2is and diuretics will also be assessed. The purpose of this study is to explore the clinical characteristics of people with type 2 diabetes in an English primary care setting that were prescribed SGLT2is, with a specific focus on their renal function and history of heart failure.
However, it is not well understood at this time whether the co-administration of certain medications may influence prescribing choices among patients with type 2 diabetes. The concomitant use of loop diuretics and SGLT2is, for example, should be avoided because of the potential risk of volume depletion in patients. In a time of emerging treatment options that may offer benefits to patients with cardiorenal disease complications, there is an increasing need to understand the impact of the choice of medications according to other clinical conditions. The increasing prevalence of cardiovascular and renal diseases in patients with type 2 diabetes has led to a broader disease management goal of reducing adverse clinical complications in patients with type 2 diabetes. People with an eGFR of less than 60 mL/min/1.73 m 2 are excluded for initiation of SGLT2is, and an eGFR of less than 45 mL/min/1.73 m 2 is the level to withdraw this medication. This mode of action has been the trigger to use an estimated glomerular filtration rate (eGFR) as a threshold for their use. Hence, their effectiveness in reducing hyperglycaemia relies upon normal renal glomerular-tubular function, which diminishes in people with renal impairment.
SGLT2is have a unique mode of action and are classified as insulin independent that prevent the reabsorption of glucose, thereby facilitating its excretion in urine. Sodium-glucose co-transporter 2 inhibitors (SGLT2is) are increasingly prescribed in the management of type 2 diabetes either as initial monotherapy in persons who cannot tolerate metformin or as add-on to metformin and other glucose-lowering drugs. The study will inform how SGLT2is are prescribed in real-world clinical practice according to renal function and a history of heart failure Additionally, we will explore whether renal function and heart failure are independently associated with SGLT2i inhibitor prescribing
We will conduct a cross-sectional analysis using the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database to calculate the percentage of people prescribed SGLT2is according to their renal function, presence of heart failure (stratified by body mass index), and co-prescribing of diuretics. The study protocol describes our planned methods to describe the clinical characteristics of people with type 2 diabetes prescribed SGLT2is in English primary care, with a specific focus on renal function and heart failure diagnosis However, recent evidence from clinical trials confirm that SGLT2is have renal and heart failure benefits that are independent of the glucose-lowering effects, and it is currently unknown whether the presence of these clinical conditions may influence prescribing choices in individuals with type 2 diabetes Sodium-glucose co-transporter 2 inhibitors (SGLT2is) are not recommended in people with impaired renal function as a result of their reduced efficacy for improving glycaemic control in this group
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