Study recommends SGLT2 inhibitors for people with diabetic foot disease

People with a history of foot ulcers or amputations should be prescribed SGLT2 inhibitors, according to new research led by a team from Leicester. 

Professor Kamlesh Khunti, Dr Patrick Highton and a team of experts have identified a general clinical confidence in prescribing SGLT2 inhibitors to people with diabetes-related foot disease, so long as they do not have an active ulcer and the drug canagliflozin is not prescribed.

In addition, the study has outlined that SGLT2 inhibitors should be prescribed to people with type 2 diabetes with concurrent heart failure and/or chronic kidney disease, regardless of ulceration status. 

Currently, there is uncertainty among clinicians whether to use SGLT2 inhibitors in people with diabetic foot ulcer disease. The objective of this study was therefore to develop consensus-driven clinical recommendations for the use of SGLT2 inhibitors in the management of diabetes and its related foot complications.

Using an online Delphi technique, healthcare practitioners from a range of relevant clinical backgrounds were asked to rate their agreement with various statements related to prescribing SGLT2 inhibitors in people with diabetic foot ulcer disease. 

Published in the journal Diabetes, Obesity and Metabolism, the research was conducted as part of the National Institute for Health and Care Research (NIHR) and Diabetes UK co-funded programme grant MiFoot. Designed to investigate how to improve cardiovascular risk in those with diabetic foot ulcer disease, the project is also supported by the NIHR Applied Research Collaboration (ARC) East Midlands. 

Lead author Dr Highton, Research Fellow for the NIHR ARC East Midlands, said: “Through this study, we have been able to capture the views of clinicians working across diabetes care and understand their attitudes toward prescribing SGLT2 inhibitors in people with diabetic foot disease. 

“Given the complexities involved in managing diabetic foot complications, it is vital that treatment decisions are informed by both clinical experience and consensus-based recommendations.”

He added: “We hope our findings will support healthcare professionals in making safe, effective choices for this high-risk population.”

Senior author Professor Khunti, Director of NIHR ARC East Midlands and Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester, explained: “Diabetic foot disease remains one of the most serious and costly complications associated with diabetes, often leading to hospitalisation, lower limb amputation, and increased mortality. 

“Yet despite these risks, there has been a lack of clear guidance on the safe use of SGLT2 inhibitors in this patient group.”

He continued: “By bringing together a wide range of clinical experts and using a rigorous Delphi approach, this study offers much-needed clarity and practical recommendations. 

“Our goal is to empower clinicians with the confidence and evidence they need to manage these people proactively and effectively, helping to reduce disparities and improve long-term outcomes.”

NIHR ARC East Midlands funds vital work to tackle the region’s health and care priorities by speeding up the adoption of research onto the frontline of health and social care. The organisation puts in place evidence-based innovations which seek to drive up standards of care and save time and money. 

NIHR ARC East Midlands is hosted by Nottinghamshire Healthcare NHS Foundation Trust and works in collaboration with the Health Innovation East Midlands. It has bases at the University of Leicester and the University of Nottingham. 

To access the full research study, click here.