ABSTRACT
INTRODUCTION: Sodium-glucose co-transporter 2 (SGLT2) inhibitors, or gliflozins, are used as mono or combined therapy in the management of diabetes. Genital infections are the most common reported adverse effect, as a result of induced glycosuria. Cutaneous features of patients experiencing vulval symptoms while on SGLT2 inhibitor therapy have not been clearly described in published literature. We have observed a specific inflammatory vulvitis with psoriasiform features in patients taking SGLT2 inhibitors, related to candidiasis in most cases. METHODS AND RESULTS: Demographic and treatment outcomes of 11 patients with characteristic inflammatory changes after starting SGLT2 inhibitors were extracted from electronic records. Ninety-one percent (n = 10) had candidiasis, treated with fluconazole. Six (54.5%) were able to continue SGLT-2 inhibitors through the addition of topical treatments, but five patients had to discontinue the drug. CONCLUSIONS: SGLT2 inhibitors can result in characteristic inflammatory vulvitis. Treatment with topical agents and single-dose antifungals may allow patients to continue their therapy to achieve improved glycemic control. In resistant cases, discontinuation of the drug is necessary. We highlight this effect so that early treatment can be initiated to alleviate symptoms and recognition of underlying cause.
Subject(s)
Candidiasis , Diabetes Mellitus, Type 2 , Sodium-Glucose Transporter 2 Inhibitors , Vulvitis , Female , Humans , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Hypoglycemic Agents/adverse effects , Sodium-Glucose Transporter 2/therapeutic use , Diabetes Mellitus, Type 2/drug therapy , Vulvitis/chemically induced , Vulvitis/drug therapy , Candidiasis/chemically inducedABSTRACT
Handover has long been identified as a potential source for error that can have direct consequences for patient care. The current weekend handover system at University College Hospital, London, involved a verbal handover meeting with a variety of methods used to collate information. A new handover system was introduced that involved the pre-population of a spreadsheet before attending the handover meeting. Doctors involved in the handover process were canvassed for opinion before and after the introduction of the new system, and logistical data were collected. The new system reduced the amount of time spent preparing for, and delivering, handover, and was deemed to be safer and to improve adherence to the Royal College of Physicians' guidelines for handover, including specification of level of doctor to perform handover and prioritisation of handover.
