Kartläggning av SGLT2-hämmares effekt på HbA1c vid uppföljning

Sammanfattning: Background and Objective: According to national and regional treatment guidelines, metformin is the first choice and SGLT2-inhibitors may be added in case of insufficient effect of metformin or other comorbidities. SGLT2 inhibitors as add-on to metformin lowers HbA1c further 5-9 mmol/mol. The aim of this study was to map the effect of SGLT2 inhibitors on HbA1c at follow-up and map how many patients that remains on SGLT2 inhibitors with insufficient effect. Study design: A retrospective study in which patients with diabetes type 2 who received a prescription for SGLT2 inhibitors from Visby Norr or Visborg health care center during the period 2018-06-30 to 2020-06-30 was identified. HbA1c, kidney function and weight were registered in an Excel-file at insertion of the SGLT2 inhibitor and at the first follow-up after insertion. Setting: Visby Norr and Visborg health care centers in Gotland. Main outcomes measures: The change in HbA1c after insertion of SGLT2 inhibitors and the proportion of patients who had insufficient effect (HbA1c reduction < 5 mmol/mol) at follow-up. Results: A total of 102 patients was included in the analyze. Following SGLT2 inhibitors was prescribed empagliflozin (91%) and dapagliflozin (9%). Mean follow up visit was within five months after insertion of the SGLT2 inhibitor. The mean decrease in HbA1c was 10 mmol/mol (95% confidence interval 7-13 mmol/mol). There were 21 individuals (21%) who achieved an HbA1c decrease < 5 mmol/mol (mean decrease in this group was 3 mmol/mol), 61 (60%) achieved an HbA1c decrease > 5 mmol/mol (average decrease in this group was 18 mmol/mol) and 20 subjects (19%) had increased HbA1c. Conclusion: In summary, the study shows that five months after insertion of SGLT2 inhibitor resulted in a decrease in HbA1c by 10 mmol/mol. At follow-up 40% of the population had an insufficient effect on HbA1c after insertion of the SGLT2-inhibitors.