Lecture and Webinar Notes

Notes from Lectures and Webinars

• Update on T2DM Management in Primary Care: Cardiorenal Protection
• 14/05/2026, 19:00–20:30 AEST
• Prof. Sarah Jenkins, Endocrinologist (Royal Melbourne Hospital)
• Main topics: First-line and second-line pharmacotherapy in T2DM, SGLT2i and GLP-1 RA indications independent of HbA1c, PBS prescribing criteria updates, and sick day management protocols.
• Early initiation of SGLT2i (e.g., empagliflozin (Jardiance®) 10 mg PO OD or dapagliflozin (Forxiga®) 10 mg PO OD) is recommended for all T2DM pts with established CVD, HFrEF, HFpEF, or CKD (eGFR 25–75 mL/min/1.73 m² with uACR > 3.5 mg/mmol).
• GLP-1 RAs (e.g., semaglutide (Ozempic®) 0.25 mg SC weekly titrated to 1 mg SC weekly) remain the preferred injectable over basal insulin for weight reduction and ASCVD risk reduction.
• An acute eGFR dip of up to 25% within the first 4 weeks of starting an SGLT2i is haemodynamic and expected; do not cease therapy unless the pt is hypovolaemic or the eGFR drop exceeds 30%.
• Euglycaemic DKA is a critical risk with SGLT2i: withhold 3 days prior to major surgery or procedures requiring bowel prep (4 days for ertugliflozin (Steglatro®)).
• Q: Can we continue SGLT2i if eGFR drops below 25 mL/min/1.73 m² during treatment? A: Yes, if already established on therapy for CKD/HF, continue until dialysis is initiated, though glucose-lowering efficacy is minimal at this threshold.
• Q: How to manage recurrent mycotic genital infections in pts on SGLT2i? A: Advise strict perineal hygiene and treat acute episodes with topical azoles or fluconazole (Diflucan®) 150 mg PO stat; only cease SGLT2i if infections are severe or frequently recurrent despite prophylaxis.
• Resources: Australian Evidence-Based Clinical Guidelines for Diabetes (Living Guidelines 2026); ADS Sick Day Management Action Plan handout; updated PBS Authority streamline codes handout.
• Action for clinic: Audit active T2DM recall register to identify pts with CKD stage 3a/3b not currently prescribed an SGLT2i. Update practice nurse chronic disease management (GPMP) templates to automatically include the ADS Sick Day handout for all pts on SGLT2i, metformin, or sulfonylureas. Log 1.5 hours of RACGP CPD (Educational Activities).