Primary care intervention increases prescriptions for SGLT2 inhibitors, GLP-1 agonists

A 30-minute educational intervention for primary care physicians increased prescribing rates of SGLT2 inhibitors and GLP-1 agonists among patients with type 2 diabetes and risk factors for atherosclerotic CVD, according to researchers.

At the Society of General Internal Medicine annual meeting, Elizabeth Carson, MD, an internal medicine resident at the University of Vermont Medical Center, and colleagues reported that prescriptions for SGLT2 inhibitors and GLP-1 agonists may be lagging behind guideline recommendations in the U.S. They noted that most patients with type 2 diabetes also have risk factors for atherosclerotic CVD (ASCVD) and would benefit from treatment with an SGLT2 inhibitor or GLP-1 agonist.

“I developed this project because these two classes of medications (SGLT2 inhibitors and GLP-1 agonists) have demonstrated significant benefits for cardiovascular health in multiple trials since 2015,” Carson told Healio. “Yet, many patients with diabetes who stand to benefit are not yet on them. I wanted to see if we could increase prescribing by creating a short educational intervention for PCPs and scheduling patients in clinic to discuss whether one of these medications might be right for them.”

The educational intervention focused on prescribing guidelines, risks and adverse events associated with the medications, dose titration, how to counsel patients and coverage estimates for patients with Medicaid or Medicare. It was offered to residents at an internal medicine primary care resident practice at the University of Vermont. After the intervention, the residents then offered diabetes medication management visits to eligible patients who were not already receiving an SGLT2 inhibitor or GLP-1 agonist.

Of the 116 patients with type 2 diabetes who were eligible to participate in the study, 51 completed a diabetes medication management visit, according to the researchers. Overall, 35% of patients started treatment with an SGLT2 inhibitor at the initial or follow-up visit, and 27% started treatment with a GLP-1 agonist.

Most patients who completed a diabetes medication visit had multiple ASCVD risk factors, Carson and colleagues noted. Nearly 80% had hypertension, 65% had hyperlipidemia, 24% had coronary artery disease, another 24% had chronic kidney disease, 10% were current smokers and 4% had congestive heart failure.

Of the 46 residents who participated in a post-visit survey, 87% said they were more likely to prescribe SGLT2 inhibitors and GLP-1 agonists after the intervention, the researchers reported. The most common reasons for not prescribing these medications included competing priorities during the visit and co-management of diabetes medications with an endocrinologist. A smaller proportion of PCPs (4%) said they did not prescribe the medications due to concerns about cost.

“It’s hard to argue with superiority of these medications over older diabetes medications,” Carson said. “As they become more available to patients due to better insurance coverage, I believe that cost is becoming less of a barrier.”

Overall, the findings underscore the importance of implementing a team-based approach to diabetes care and enhancing communication between PCPs and specialists, according to the researchers.

Carson said that concise education will be key to improving prescribing rates “because we only prescribe drugs that we are familiar and comfortable with.”

“Primary care practitioners do the bulk of diabetes management in the U.S.,” she said. “They are also familiar with their patients’ comorbidities and have a good understanding of their patients’ overall cardiovascular risk. They can therefore easily identify who is most likely to benefit. If they feel well-informed about SGLT2 inhibitors and GLP-1 agonists, they are more likely to prescribe them.”