Introduction and Objective: SGLT-2 inhibitors (SGLT-2i) reduce heart failure (HF) hospitalization among HF patients and slow kidney disease progression and lower cardiovascular risk among patients with chronic kidney disease (CKD). We estimated the proportion of patients with type 2 diabetes and either HF or CKD with an active prescription for an SGLT2i and identified factors associated with prescribing.Methods: We conducted a cross-sectional analysis of adults with type 2 diabetes seen at one of 40 primary care practices in the mid-Atlantic region in 2023 using electronic health record data. Diabetes and HF were defined using ICD-10 codes while CKD was defined based on Kidney Disease Improving Global Outcomes diagnostic criteria. An SGLT2i prescription was defined as active as of 12/31/2023 or reported as such by the patient. We examined age, gender, race, ethnicity, area deprivation index, insurance class, hemoglobin A1c (A1c), and body mass index, with statistical comparison by ANOVA and Chi-squared tests.Results: Among 23,225 patients with type 2 diabetes seen in primary care, median age was 65 years; 49.1% were white, 36.3% African American, 3.5% Hispanic, and 51% women. 13.7% had CKD and 9.0% had HF. Overall, 20.2% of patients with diabetes had an active SGLT-2i prescription, versus 28.8% and 35.3% for those with CKD and HF, respectively. Patients with CKD or HF prescribed an SGLT2i were younger, and more often male or had A1c >7% compared to those not prescribed (A1c >7%: CKD, 51.5% vs. 36.2%; HF, 44.8% vs. 33.5%, p<0.001 for both comparisons). Among HF patients prescribed an SGLT2i, a greater proportion were African American compared to those not prescribed, which was not seen in CKD (HF, 44.0% vs. 34.8%; CKD, 49.1% vs. 51.1%).Conclusion: Most patients with diabetes and HF or CKD do not currently receive indicated SGLT2i. Interventions are needed to increase prescribing among these patients, particularly among those with adequate glycemic control.
N.M. Maruthur: None. L. Yanek: None. N.N. Mathioudakis: None. E. Michos: Consultant; Amgen Inc, Boehringer-Ingelheim, Novo Nordisk, Edwards Lifesciences, Eli Lilly and Company, Ionis Pharmaceuticals, NewAmsterdam Pharma, Bayer Pharmaceuticals, Inc, ESPERION Therapeutics, Inc., Arrowhead Pharmaceuticals, Inc. C. Cervantes: None. J. Wu: None. S. Pitts: None.
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