Table 4

Educational components of a risk mitigation strategy when introducing SGLT inhibitors for type 1 diabetes

Patient education• All patients initiating SGLT inhibitor therapy should receive through training/education in the following areas:
 ◦DKA causes and symptoms
 ◦Euglycemic ketoacidosis
 ◦Importance of ketone monitoring
 ◦Use of ketone monitoring—training in testing procedure, proactive monitoring, situations when monitoring is indicated
 ◦Treatment protocol for addressing ketosis
 ◦Guidance in when to seek medical attention
Clinician education• All prescribing clinicians should acquire full understanding of the safe use and risks associated with SGLT inhibitor therapy:
 ◦Criteria for patient selection—baseline ketone level, demographic/behavioral considerations
 ◦Training/educational needs of patients—detection (ketone levels, symptoms), prevention strategies, treatment
 ◦Potential for missed DKA, euDKA
 ◦Treatment strategies—STICH protocol recommended:
  ▪ STop SGLT inhibitor treatment for a few days
  ▪ Insulin administration
  ▪ Carbohydrate consumption
  ▪ Hydration with a suitable drink (e.g., water or noncaloric athletic drink with balanced electrolytes)
Risk Communication• Product labeling, website
• Health care professional education
• Medication guide, patient alert card*