Abstract P499: Patterns of Sodium Glucose Cotransporter-2 Inhibitor Prescription by Indication in Patients With and Without Diabetes in the US Health System

Introduction: Multiple clinical practice guidelines strongly recommend sodium-glucose cotransporter-2 inhibitors (SGLT2i) for people with diabetes and atherosclerotic cardiovascular disease or chronic kidney disease as well as for people with urine albumin-to-creatinine ≥200 mg/g or heart failure (HF), regardless of diabetes status. We characterized SGLT2i prescription patterns by indication for SGLT2i therapy in patients with and without diabetes in the US in 2022. Hypothesis: The prescription of SGLT2i is low across all indications. Methods: Using deidentified electronic health record data from the Optum Labs Data Warehouse, we included adults with estimated glomerular filtration rate ≥20 ml/min/1.73 m 2 across 31 US health systems. We assessed prevalence of SGLT2i prescription by presence of diabetes and indication, and compared them with renin-angiotensin system inhibitors (RASi), which were background therapies in the landmark trials of SGLT2i. Results: We classified 760,337 patients with diabetes and 2,640,077 patients without diabetes by their indications for SGLT2i therapy (indication present, absent, or unknown due to lack of albuminuria testing). SGLT2i were prescribed in 11.2%, 11.2%, and 7.1% of patients with diabetes and indication present, absent, or unknown, respectively, and 2.5%, 0.1%, and 0.1% of patients without diabetes. In contrast, RASi were prescribed more frequently among patients with indication present (with diabetes: 31-44%; without diabetes: 16-33%). RASi were prescribed to the majority of patients prescribed SGLT2i ( Figure A ). Practice patterns varied across health systems, but <30% of patients with an indication received a SGLT2i prescription in all systems. ( Figure B ). Conclusions: In this large-scale analysis of contemporary US data, prescription of SGLT2i is low, which may deprive patients of needed cardiorenal protection. Future work should investigate whether changes in costs enabled by the 2022 Inflation Reduction Act may stimulate more optimal prescription patterns.