PRESCRIBING PATTERNS OF SGLT2 INHIBITORS IN TYPE 2 DIABETES MANAGEMENT AT A TERTIARY CARE CENTER IN MALAYSIA

Abstract

INTRODUCTION
Type 2 diabetes (T2D) continues to pose a significant public health challenge in Malaysia, affecting approximately 20% or 4.4 million adults. Among the newer treatment options, sodium-glucose co-transporter-2 inhibitors (SGLT2-i) have gained increasing attention due to their proven glycaemic and cardiorenal benefits. Despite the increasing adoption of SGLT2-i due to established glycaemic and cardiorenal benefits, Malaysia-specific prescribing patterns remain understudied, particularly in tertiary healthcare environments. This study aimed to evaluate the prescribing patterns of SGLT2-i and its relationship with antidiabetic utilization in T2D patients at Hospital Kuala Lumpur.

METHODOLOGY
This retrospective cohort study used patient data from the Pharmacy Information System (PhIS) and Lab Management System (LMS). Patients aged 18–70 years diagnosed with T2D and prescribed empagliflozin or dapagliflozin between January - December 2023 were included. Data on demographics, initiation date of SGLT2-i, medication history, and HbA1c levels were extracted. Adherence to prescribing guidelines was assessed by comparing initiation criteria, dosing, and drug combinations against recommendations outlined in the Malaysian Clinical Practice Guidelines (6th edition). Medication adherence was measured using the Medication Possession Ratio extracted from PhIS. HbA1c levels before and after SGLT2-i treatment in adherent patients were compared using the Wilcoxon signed-rank test, with a significance level set at 0.05.

RESULT
Among the 256 patients analyzed, 77.3% of prescriptions adhered to national guidelines, with excellent dose compliance (97.3%). Combination therapy was predominant (98%), with metformin (82%), vildagliptin (54%), and gliclazide (20%) most frequently prescribed concurrently. Additionally, 60.2% received insulin concurrently with SGLT2-i. Notably, adherent patients experienced significant HbA1c reductions from a median baseline of 7.5% to 7.2% post-treatment (p = 0.019).

CONCLUSION
SGLT2-i prescribing practices at HKL closely align with national guidelines, primarily involving combination therapy. The observed significant improvement in glycaemic control among adherent patients underscores the value of SGLT2-i in routine clinical management of T2D. Future research should focus on long-term clinical outcomes and economic implications of widespread SGLT2-i use.