Background: Sodium-glucose transport protein 2 inhibitors (SGLT-2i) are antidiabetic drugs that have shown to aid in all-cause/cardiovascular mortality along with progression of renal disease. Though SGLT2i have many benefits, there are many instances where these medications need to be held or discontinued; preoperatively (72h-92h prior to surgery), hypotension, reduced oral intake, decrease in eGFR, urinary tract infections (UTIs), to help avoid diabetic complications such as euglycemic Diabetic ketoacidosis (eDKA). With recent increase in use of SGTL2i, more patients have been linked with eDKA, and therefore a Best Practice Advisory (BPA) was created in December 2021, to trigger a discontinuation of SGTLT2i on admission into the hospital, as well as provide a reminder to restart on discharge.
Purpose: This project aimed to see what actions are taken by the provider on the BPA alert and see if the advisory is an effective way to prevent eDKA events by discontinuing SGTLT2i’s, as well as resume SGTL2i’s on discharge in adults ages 18-95 years old at Morristown Medical Center by from January 2018 to March 2023.
Description: Intervention: After the creation of the BPA, we monitored monthly intervals from December 2021 until March 2023, tracking the frequency of the BPA firing and what action was taken; if providers opted to open an order set to discontinue the SGLT2i medications or override the order set (Figure A and C). The BPA also was set to fire on discharge as a reminder to effectively restart SGTL2i in the appropriate setting. Follow up actions as well as overrides were monitored as to what the provider chose on discharge
Conclusions: Outcome: With the BPA firing for patients on antiglycemic medications, there was an average of 116% of actions taken to discontinue SGTL2i medicationsOn discharge with the BPA alert, there was an average of 22% of providers that took a follow up action.This data set showed that there are many beneficial outcomes in creating the BPA alert, with a large number of actions taken on admission to discontinue SGLT2i and therefore likely decreasing the incidence of eDKA.
