From the Research
SGLT2 inhibitors for diabetes can be safely reintroduced once the cellulitis has resolved, the patient is clinically stable, and has transitioned from IV to oral antibiotics, as supported by the most recent study 1 that highlights the risks associated with the use of SGLT2 inhibitors for inpatient management of hyperglycemia. When considering the reintroduction of SGLT2 inhibitors, it is crucial to prioritize the patient's clinical stability and the resolution of the cellulitis. This typically means waiting until the patient is afebrile for at least 24-48 hours, shows reduced erythema and swelling, has normal or improving renal function, and is able to maintain adequate oral intake and hydration. The decision to restart SGLT2 inhibitors should be based on the individual patient's condition, taking into account the potential risks and benefits of these medications. As noted in the study 2, certain factors such as prior diabetic ketoacidosis, baseline hemoglobin A1C level, and baseline creatinine level can increase the risk of complications associated with SGLT2 inhibitors. Before restarting SGLT2 inhibitors, ensure the patient understands proper foot care and the importance of monitoring for signs of infection, as these medications slightly increase the risk of genital infections and potentially recurrent cellulitis, as mentioned in the study 3. Key considerations for the reintroduction of SGLT2 inhibitors include:
- Clinical stability of the patient
- Resolution of cellulitis
- Normal or improving renal function
- Ability to maintain adequate oral intake and hydration
- Patient education on proper foot care and monitoring for signs of infection By carefully evaluating these factors and considering the most recent evidence, healthcare providers can make informed decisions about the safe reintroduction of SGLT2 inhibitors for patients with diabetes who have undergone initial IV antibiotic treatment for cellulitis.