Title : Use of SGLT2-i in treatment of established Coronary Artery Disease (CAD) in diabetic patients
Abstract:
Introduction: To optimise patinet outcomes the National Institiute of Health and Care Excellence (NICE) has issues guidelines in Aug, 2022 recommending use of Sodium Glucose Co Transporter Inhibitor (SGLT-2i) in diabetic patients with established atherosclerotic coronary artery disease. Similar suggestions are given in European Society of Cardiology (ESC) 2023 guidelines 1 and American College of Cardiology (ACC) 2025 guidelines 2 emphasizing the use of Glucagon Like Peptide Receptor Agonist (GLP-1RA) and/or SGLT2-i in diabetic population.
Aim: This audit was done to make sure that patients presenting with Acute Coronary Syndrome (ACS) are screened for diabetes mellitus and if their Coronary Angiogram (CA) shows significant coronary artery disease and they are diabetic, then they receive SGLT2-i irrespective of their target HbA1c.
Methodology: The study is an observational retrospective analysis done on the patients who have undergone coronary angiogram or Percutaneous Coronary Intervention (PCI) between November 2024 – January 2025. Inclusion criteria were set to include patients having evidence of CAD on CA. Data was collected using electronic records including keeping system and clinic letters. Data was analysed using Microsoft Excel.
Key Findings: We found out that out of 149 patients, 66% (n=99) were screened for DM during the hospital stay. And out of those 66% screened patients, 30.3% (n=30) patients had their HbA1c in diabetic range, which was quite significant. Pooled analysis showed that total diabetic patients made 30% (n=44.7) of the study population and out of them SGLT2-i was prescribed to only 42% (n=17), which also included the patients who were already on SGLT2-i. Regardless, 58% (n=26) diabetic patients were not considered for SGLT2-i, neither as in-patient nor recommended as out-patient on discharge summary.
Conclusions: As such, in patients with diabetes and Atherosclerotic Cardiovascular Disease (ASCVD), treatment with Glucagon Like Peptide Receptor Agonist (GLP-1RA) and/or SGLT2-i is recommended to reduce cardiovascular risk, independent of glucose control and in addition to standard of care, e.g. Antiplatelet, anti-hypertensive, or lipid-lowering therapy. This Audit shows that we are not fully screening the patients for a major risk factor of CAD and with regards to consideration of starting patients on SGLT-2i, there is a room for improvement.
Recommendations: We should make sure to screen patients with established CAD for diabetes and if their HbA1c is in diabetic range and there are no contraindications to start SGLT2i then they should be offered SGLT2-i as a guideline directed treatment.
