Endocrine Abstracts

Introduction: Sodium Glucose Co-transporter 2 inhibitors (SGLT2i) are a novel class of glucose-lowering therapies that have demonstrated prognostic benefit in the management diabetes, heart failure and renal impairment. National Institute for Health and Clinical Excellence (NICE) guidance recommends offering SGLT2i, in addition to metformin, first-line in individuals with type 2 diabetes (T2D) and chronic heart failure/ established atherosclerotic cardiovascular disease. However, SGLT2i require close monitoring and rarely can result in life-threatening complications including euglycaemic diabetic ketoacidosis. Therefore, foundation doctors (FDs) (Newly graduated Doctors undertaking the two years foundation training programme) should be competent in their use and early identification of side effects.

Aim: We conducted a quality improvement project to assess FDs’ knowledge on the use of SGLT2i, provide educational material and thus improve patient care at Northwick Park Hospital (NPH).

Method: A questionnaire was designed within the department of Endocrinology encompassing 4 key domains including initiation, indications, benefits, and side effects of SGLT2i. FDs (FY1/ FY2) were invited to complete the initial questionnaire between October-November 2022. Within the second cycle, we designed and delivered educational material. This was by a re-audit.

Results: Of 80 FDs at NPH, 32 individuals completed the initial questionnaire. 40%(n=13) were able to recall the indications of SGLT2i and 44%(n=14) were well-informed on cardiovascular and renal benefits. 56%(n=18) were aware of the appropriate eGFR prior to initiation. 56% (n=18) could recollect stopping SGLT2 inhibitors during acute illness whilst only 16%(n=5) were aware of management of euglycaemic ketoacidosis. 59%(n=19) appreciated the low incidence of hypoglycaemia. Overwhelmingly, 75%(n=24) of individuals received no prior formal education on SGLT2i. Therefore, we delivered a formal teaching session specifically targeted at FDs. Individuals completed the same questionnaire post-teaching, and 38 responses were collated. Ability to recall indications for use of SGLT2i increased to 74%(n=28) and 66%(n=25) were now aware of the beneficial cardiovascular and renal outcomes. 74%(n=28) could identify the safe eGFR range for commencing SGLT2i. 95%(n=36) appreciated importance of stopping SGLT2i in periods of acute illness whilst 74%(n=28) were confident on management of euglycaemic ketoacidosis.

Conclusion: This quality improvement project demonstrated a significant knowledge gap amongst FDs on SGLT2i. By providing focused and targeted educational initiatives, we have demonstrated an improvement in knowledge across all four essential domains. To ensure sustainability, we propose FDs nationally should receive bi-annual teaching sessions on the ever-evolving field of managing T2D.