The use of SGLT2 inhibitors in people with diabetes-related foot disease: A Delphi-based consensus study

To generate expert consensus-based clinical recommendations on the use of SGLT2 inhibitors in those with diabetes and diabetes-related foot disease (DFD).

This study employed a two-round online Delphi technique. Participants were healthcare practitioners from a range of relevant clinical backgrounds, recruited using convenience sampling. The statements for consideration were iteratively developed by study team members with expertise in managing diabetes and prescribing SGLT2 inhibitors, supported by key professional organisations and people with lived experience of DFD. Statements were ranked using a 6-point Likert Scale from Strongly Agree to Strongly Disagree. Consensus status for each statement was based on the Average Percent of Majority Opinions for each statement.

Twenty-one participants completed round 1 of the survey, with 19 completing round 2. Participants represented a diverse range of healthcare professions, including Diabetologists, General Practitioners, Nurses and Pharmacists. Of the 25 total statements, 16 reached consensus (13 in round 1 and 3 in round 2), including: agreement on prescribing SGLT2 inhibitors to people with type 2 diabetes (regardless of ulceration status) with concurrent heart failure and/or chronic kidney disease; agreement that those with a previous healed ulcer or amputation should be prescribed SGLT2 inhibitors; disagreement that SGLT2 inhibitors per se increase amputation risk; agreement that canagliflozin should be avoided in this group.

These findings evidence the relative confidence of experienced clinicians in prescribing SGLT2 inhibitors to those with DFD, provided that they do not have a current ulcer and that canagliflozin is not prescribed.