SGLT2 Inhibitors: Practical Guidance for Clinicians and Formularies

In "SGLT2 Inhibitors: Practical Guidance for Clinicians and Formularies," Dr. Vaduganathan closes the series with practical guidance for clinicians and payers applying SGLT2 inhibitors in practice.

Dr. Vaduganathan closes the series with practical advice for clinicians navigating SGLT2 inhibitors as both a scientific and a formulary matter. His starting point is a general principle that applies to any new, emerging, or established drug therapy: clinicians should become genuinely familiar with the clinical trial evidence underlying it, not just its high-level guideline recommendation. That familiarity, he says, positions clinicians to serve as local champions, including on hospital formulary committees, where they can help guide appropriate use of a therapy in the at-risk patients most likely to benefit.

For SGLT2 inhibitors specifically, Dr. Vaduganathan reiterates that the class sits among the most evidence-based therapies across the entire cardio-kidney-metabolic landscape, a point he has built toward throughout the series. His practical guidance is to match real-world patients as closely as possible to the populations actually studied in the pivotal clinical trials when applying the class for a given indication, rather than extrapolating loosely. He singles out dapagliflozin and empagliflozin as the two SGLT2 inhibitors with the strongest evidence base for many of the highest-risk patients, particularly those with heart failure or chronic kidney disease, since those two agents carry the deepest trial experience in those specific populations.

Dr. Vaduganathan frames this closing message as a bridge between the clinical and payer audiences the series was built for: clinicians who understand the trial data can advocate credibly on formulary committees, and payers who understand which populations the evidence actually supports can design policies that keep appropriate patients from facing unnecessary access barriers. The result, in his view, is a more consistent path from strong trial evidence to real-world use in the patients most likely to benefit.