SGLT2 Inhibitors in the Primary Health Care Setting: Consensus, Challenges, and Clinical Use

Dr AJAY CHHABRA; Dr VK DHANDANIA; Dr SUNIL MISHRA; Dr GIRISH PARMAR; Dr SUNEET VERMA; Dr MEENAKSHI VERMA; Dr DK SINGH; Dr JK RATH; Dr MK BHADANI; Dr PC RUNNU; Dr JAIKANT PRASAD; Dr AKANKSHA SONKAR; Dr SANJAY KALRA

doi:10.59793/6119kd50

Authors

Dr AJAY CHHABRA Consultant Diabetologist and Physician, Dr Chhabra’s Diabetes Centre, Raturoad, Ranchi, Jharkhand, India
Dr VK DHANDANIA Diabetes Care Centre, Agrasen Path, Ranchi, Jharkhand, India
Dr SUNIL MISHRA Director, Dept. of Endocrinology and Diabetes, GEIMS, Dehradun, India
Dr GIRISH PARMAR Director - Endocrinology, Endocrinology & Diabetes, Paediatric (Ped) Endocrinology, Nanavati Max Hospital, Mumbai, Maharashtra, India
Dr SUNEET VERMA Senior Consultant Physician and Diabetologist, Sparsh Clinic and Alchemist Hospital, Panchkula, Haryana, India
Dr MEENAKSHI VERMA Senior Pediatrician, Sparsh Clinic, Panchkula, Haryana, India
Dr DK SINGH Consultant Physician, Ashok Nagar, Ranchi, Jharkhand, India
Dr JK RATH Ex-CMO, ISPAT Hospital, Ranchi; Honorary CMO, Ramakrishna Mission TB Sanatorium, Ranchi, Jharkhand, India
Dr MK BHADANI Consultant Physician and Cardiodiabetologist, Amrawati, Lalpur, Ranchi, Jharkhand, India
Dr PC RUNNU Consultant Physician, KC Roy Memorial Hospital, Lalpur, Ranchi, Jharkhand, India
Dr JAIKANT PRASAD Ex-Resident, Safdarjung and Dr. Ram Manohar Lohia Hospital, New Delhi, India
Dr AKANKSHA SONKAR Medical Affairs, Zydus Healthcare Ltd, Zydus Tower, Goregaon East, Mumbai, Maharashtra, India
Dr SANJAY KALRA Treasurer, International Society of Endocrinology (ISE); Vice President, South Asian Obesity Forum (SOF); Bharti Hospital, Karnal, Haryana, India

DOI:

https://doi.org/10.59793/6119kd50

Keywords:

Sodium-glucose cotransporter 2 inhibitors,, type 2 diabetes mellitus,, heart failure,, chronic kidney disease,, multiple metabolic benefits

Abstract

Sodium-glucose co-transporter 2 (SGLT2) inhibitors represent a major advancement in the pharmacological management of
type 2 diabetes mellitus (T2DM), with robust evidence demonstrating benefits beyond glycemic control. They offer additional
health benefits such as lowering the risk of heart failure hospitalizations, slowing chronic kidney disease (CKD) progression,
and improving cardiovascular, renal, and metabolic health. The effective use of SGLT2 inhibitors also relies on comprehensive
patient education and counseling. Patients must understand the medication's benefits, such as reducing blood sugar and
preventing complications, and be instructed to stop the medication during acute illnesses or surgeries. It is vital to advice against
discontinuing use without medical guidance due to potential risks. Routine check-ups for clinical status, blood glucose, and
kidney-heart function are essential for safety and effectiveness. However, the application of SGLT2 inhibitors in primary care
settings in rural India, specifically in Jharkhand, is low due to high costs, lack of provider awareness, insufficient monitoring
systems, and treatment hesitance. Furthermore, no peer-reviewed data is available to assess their use in this region. Hence, a
structured questionnaire was created by expert groups and distributed to endocrinologists, cardiologists, and general physicians.
Using the DELPHI methodology, consensus statements were formed based on evidence and reviewed by 12 experts from India.
Statements that garnered over 65% agreement in discussions were included in the final consensus. The consensus emphasized
that SGLT2 inhibitors benefit T2DM, heart failure, and CKD, with safe, structured use and integration into primary care being
key to maximizing cardio-renal-metabolic outcomes.