When should SGLT2 blockers be used in ischaemic heart disease?

SGLT2 inhibitors should be used in patients with ischaemic heart disease who have type 2 diabetes as part of their treatment regimen after first-line therapy. Specifically, for adults with type 2 diabetes who have established atherosclerotic cardiovascular disease, which includes ischaemic heart disease, an SGLT2 inhibitor with proven cardiovascular benefit should be offered in addition to current treatment or as a replacement for an existing drug.

This use is recommended regardless of the stage of diabetes treatment, emphasizing cardiovascular protection alongside glycaemic control.

Before starting an SGLT2 inhibitor, assess for increased risk of diabetic ketoacidosis and address modifiable risks.

Shared decision-making should guide whether to add or switch to an SGLT2 inhibitor, considering the patient's current treatment, preferences, and potential benefits.