SGLT2 inhibitors greatly underprescribed in patients who qualify for them
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Key takeaways:
- Most patients who qualify for an SGLT2 inhibitor are not prescribed one.
- Prescription rates for those with a class 1a recommendation are about 11% for those with diabetes and 3% for those without diabetes.
In an analysis of more than 3 million U.S. adults, most patients with a class 1a recommendation for SGLT2 inhibitors were not prescribed them, researchers reported in the Journal of the American College of Cardiology.
Jung-Im Shin, MD, PhD, assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, and colleagues assessed SGLT2 inhibitor prescription rates for 3,189,827 adults from 28 U.S. health systems who appeared in the Optum Labs Data Warehouse database from April 2022 and March 2023.
The drugs “reduce heart failure (HF) hospitalizations, recurrent cardiovascular events, and chronic kidney disease (CKD) progression, and thus constitute a class 1a recommendation in people with diabetes and atherosclerotic cardiovascular disease, HF or CKD and in people with severe albuminuria or HF, regardless of diabetes status,” Shin and colleagues wrote.
Among the 716,387 participants with diabetes, 63.4% had a class 1a recommendation for SGLT2 inhibitor therapy, and among 2,473,440 participants without diabetes, 6.2% had a class 1a recommendation for it, Shin and colleagues found.
Prescription rates low
In the diabetes cohort, 11.9% with a class 1a recommendation for SGLT2 inhibitor therapy received a prescription (95% CI, 11.9-12), which was almost the same rate as patients with diabetes but no class 1a recommendation for SGLT2 inhibitor therapy (11.4%; 95% CI, 11.3-11.6; standardized mean difference, 1.3%).
In individuals without diabetes, among those who had a class 1a recommendation for SGLT2 inhibitor therapy, 3.1% received a prescription (95% CI, 3-3.2), according to the researchers.
In no health system did more than 25% of patients with a class 1a recommendation for SGLT2 inhibitor therapy receive a prescription for it, Shin and colleagues wrote.
Among patients with diabetes, the most common type of practitioner to issue a prescription for an SGLT2 inhibitor was a family practitioner or internist (46.7% in those with a class 1a recommendation; 60.7% in those without one), followed by an endocrinologist, and among patients without diabetes, the most common type of practitioner to issue a prescription for an SGLT2 inhibitor was a cardiologist (51.8% in those with a class 1a recommendation), the researchers found.
The highest rate of SGLT2 inhibitor prescription in any patient group was 14% in those who had all of diabetes, ASCVD, CKD and HF, according to the researchers.
“The findings demonstrate an important gap in contemporary U.S. clinical care and highlight the need for interventions to address the shortfalls in optimal SGLT2 inhibitor prescription practice,” Shin and colleagues wrote.
Clinician inertia a factor
In a related editorial, Tariq Ahmad, MD, MPH, associate professor of medicine and chief of the Heart Failure Program at Yale School of Medicine, and colleagues wrote: “A significant cause of underuse of these therapies is clinician inertia. We must, therefore, acknowledge that we can all do better, from individual providers to health care systems. We must commit to ensuring that our care is commensurate with the best clinical evidence. This means doing our best to overcome the many barriers to prescribing SGLT2 inhibitors to patients for whom they are recommended: the chaos of ambulatory care, the fear of offending a colleague by prescribing a medication that may have been their purview historically, and the need to navigate a fee-for-service system that incentivizes quantity over quality of care.”
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