Prescription Patterns for Sodium-Glucose Cotransporter 2 Inhibitors in U.S. Health Systems

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2-inhibitors) 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. Objectives: To comprehensibly characterize the rate of SGLT2-inhibitor prescriptions among people with a class 1A recommendation for SGLT2-inhibitor use. Methods: Among 3,189,827 adults from 28 US health systems within Optum Labs Data Warehouse between April 1,2022 and March 31, 2023, we assessed SGLT2-inhibitor prescription rates, stratified by presence of diabetes and class 1A recommendation. Results: Among 716,387 adults with diabetes, 63.4% had a class 1A recommendation for SGLT2-inhibitor therapy. There was little difference by class 1A recommendation status (present: 11.9% 95% CI =11.9%, 12.0% vs. absent: 11.4% 11.3%, 11.6%, SMD=1.3%). Among 2,473,440 adults without diabetes, 6.2% had a class 1A recommendation for SGLT2-inhibitor therapy, and 3.1% (3.0%, 3.2%) of those received a prescription. Internists/family practitioners initiated SGLT2-inhibitor prescriptions most commonly among people with diabetes, whereas specialists initiated SGLT2-inhibitor prescriptions most commonly among people without diabetes. No health system had >25% SGLT2-inhibitor prescription rate among people with a class 1A recommendation. Health systems with higher proportions of patients with commercial insurance and lower proportions with Medicare had higher SGLT2-inhibitor prescription rates. Conclusions: In this analysis of US data from 2022–2023, SGLT2-inhibitor prescription among people with a class 1A recommendation is low. Interventions are needed to increase uptake of guideline recommended SGLT2-inhibitor use.