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[Multidisciplinary consensus on the use of SGLT-2 inhibitors in chilean clinical practice using the GRADE
Sebastián Cabrera1, Magdalena Walbaum2, Eduardo Lorca1
1Sociedad Chilena de Nefrología, Santiago, Chile.
Insights
The Chilean consensus recommends SGLT-2 inhibitors (iSGLT-2) for heart failure, type 2 diabetes, and kidney disease. These drugs offer benefits beyond glucose control, emphasizing multidisciplinary care for cardiometabolic conditions.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
- Pharmacology
Background:
- SGLT-2 inhibitors (iSGLT-2) have demonstrated significant benefits in managing cardiometabolic conditions.
- A Chilean consensus was developed by leading medical societies to guide clinical practice.
Purpose of the Study:
- To provide evidence-based recommendations for the clinical use of SGLT-2 inhibitors in Chile.
- To outline optimal strategies for diagnosis, adherence, and education regarding iSGLT-2 therapy.
- To address safety and cost-effectiveness for prioritized implementation.
Main Methods:
- Development of a consensus document by a multidisciplinary expert panel.
- Review of current scientific evidence on SGLT-2 inhibitors.
- Formulation of clinical recommendations based on specific patient populations and conditions.
Main Results:
- Strong recommendation for iSGLT-2 in heart failure with reduced ejection fraction, type 2 diabetes mellitus for cardiovascular risk reduction, and chronic kidney disease.
- Suggested use of iSGLT-2 in heart failure with preserved/mildly reduced ejection fraction and non-diabetic chronic kidney disease.
- Recommended combination of iSGLT-2 with ACE inhibitors/ARBs in CKD and replacement of sulfonylureas in type 2 diabetes.
Conclusions:
- SGLT-2 inhibitors are crucial for managing complex cardiometabolic conditions in Chile.
- Multidisciplinary collaboration and local evidence generation are vital for maximizing iSGLT-2 benefits.
- Focus on non-glycemic benefits, safety, and cost-effectiveness is essential for implementation.
Abstract:
The Chilean consensus on the use of SGLT-2 inhibitors (iSGLT-2) in clinical practice, jointly developed by the societies of Cardiology, Diabetes, Family Medicine, and Nephrology, strongly recommends the use of these drugs in people with heart failure with reduced ejection fraction, type 2 diabetes mellitus for prevention of cardiovascular events, and chronic kidney disease. In heart failure with preserved or mildly reduced ejection fraction, and chronic kidney disease without diabetes, the consensus suggests the use of iSGLT-2. The importance of combining iSGLT-2 with ACE inhibitors or ARBs in chronic kidney disease is highlighted, and their use is recommended to replace sulfonylureas as a second-line treatment for glycemic control in type 2 diabetes. The consensus emphasizes the need for strategies to optimize diagnosis, improve adherence, and educate about benefits beyond glycemic control. Safety and cost-effectiveness considerations for prioritized implementation according to evidence are discussed. The document highlights the importance of multidisciplinary collaboration and the generation of local evidence to maximize the potential of these drugs in the management of complex cardiometabolic conditions in Chile.
