DOI: https://doi.org/10.36347/sasjm.2026.v12i06.008

Pages: 621-628

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated robust cardiovascular and renoprotective benefits in patients with type 2 diabetes mellitus (T2DM), and international guidelines including NICE strongly recommend their use in patients with established cardiovascular disease (CVD) or high CVD risk. Despite this evidence, significant prescribing gaps persist in primary care. This audit aimed to identify the extent of SGLT2i under-prescribing in a UK-based NHS primary care practice and implement a quality improvement intervention. Methods: A retrospective clinical audit was conducted using electronic patient records from an NHS primary care practice. Patients aged 17 years and above registered on the diabetic disease register with confirmed T2DM and co-existing CVD were identified. A structured review assessed current SGLT2i prescribing status, eligibility based on NICE and BSSE APC guidance, contraindications, and barriers to initiation. An invitation letter with an informational leaflet was sent to eligible patients, and their responses were recorded. Results: Of 590 patients on the diabetic register, 539 (92%) had T2DM, of whom 147 (27%) had co-existing CVD. Among these 147 patients, 110 (75%) were not currently on an SGLT2i. After systematic review, 52 patients (47%) were offered treatment and 58 (53%) were excluded due to clinical contraindications or ineligibility. The most common reasons for exclusion were pre-diabetic misclassification (44.8%), specialist care (17.2%), and ischaemic limb/foot (12.1%). Following the invitation letter initiative, a proportion of eligible patients accepted and commenced SGLT2i therapy. Conclusion: This audit demonstrates a substantial SGLT2i prescribing gap in primary care patients with T2DM and CVD. A structured invitation-based approach with patient education can improve uptake. Systematic QRISK3 assessment and regular register auditing are recommended to optimise guideline-concordant prescribing.