Background

The National Institute for Health and Care Excellence (NICE) have published technology appraisals that increase patient access to SGLT2 inhibitors for several conditions.

SGLT2 inhibitors have improved the treatment of people with type 2 diabetes (T2DM) and have been shown to be helpful in reducing the progression of CKD to end stage renal failure in people with protein in their urine whether they have diabetes or not.

This plan proposes our next steps to identify people who would most benefit from an offer of SGLT2 inhibitors with CKD.

Considerations

  • In Dorset there is high established use of SGLT2 inhibitors in T2DM and a significant degree of crossover between patients with T2DM who also have CKD

  • The clinical resources to be able to offer these medicines to people who will benefit most. There are significant workforce implications in reviewing and offering large cohorts of people with CKD and additional treatment which requires maximal treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) medicines prior to initiation

  • SGLT2 inhibitors can cause side-effects and people need counselling on what to do to reduce the risk of harm

  • Dapagliflozin and empagliflozin (both SGLT2 inhibitors) are licensed as add on therapy in CKD to optimised standard care that should include lifestyle and dietary changes and the highest tolerated licensed dose of ACE inhibitors or ARBs, unless these are not suitable

Our plan

NHS Dorset supports the proactive identification and review of people with CKD to offer SGLT2 inhibitors to people in Dorset in a phased approach to reflect the additional workforce and care implications of offering preventative treatments to large groups of people in both primary and secondary care.

Priority groups Date
People with moderate to severe CKD and severely increased protein in their urine Starting April 2025
People with moderate to severe CKD and moderately increased protein in their urine (Glomerular filtration rate ≤45 mL/min/1.73 m2 AND uACR ≥3mg/mmol) Planned from April 2027

Your healthcare professional will discuss with you if these treatments are suitable for you and discuss the risks and benefits with you.

You can expect that:

  • You will be assessed to see whether you are suitable for this preventative therapy

  • The dose of ACE Inhibitor (or ARB) will be optimised to the highest tolerated dose (unless not suitable) before starting an SGLT2 inhibitor

  • An SGLT2 inhibitor will be offered and started by an appropriately trained healthcare professional skilled in treating chronic kidney disease

  • You will be provided with lifestyle and dietary education

  • You will be counselled regarding possible adverse events and sick day rules

Timelines

NHS Dorset will work with healthcare professionals in 2025 to enable clinicians to identify people who will most benefit from being reviewed by publishing searches in SystmOne (Dorset SystmOne GPs/NICE proactive implementation folder).