Key result
SGLT2 inhibitor prescription rates remain low at ~12% despite Class 1A guideline recommendations.
Why the study?
Despite class 1A recommendations across multiple indications, contemporary rates of SGLT2-inhibitor prescriptions among eligible patients in US health systems were not comprehensively characterized.
What is the contemporary real-world prescription rate of SGLT2-inhibitors among patients with a class 1A guideline recommendation?
Cross-Sectional (n=3,189,827)
Yes
What is the contemporary real-world prescription rate of SGLT2-inhibitors among patients with a class 1A guideline recommendation?
Standardized Mean Difference: 1.3
Absolute Event Rate: 11.9% vs 11.4%
Despite strong society guidelines, SGLT2-inhibitor prescription rates remain remarkably low in clinical practice, highlighting a significant failure to implement proven cardiorenal risk-reducing therapies.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“I think it's really just consistent with [the] overwhelming culture of clinical inertia for our care of cardio-kidney-metabolic patients, and we essentially sleepwalk through chronic care of these patients. And it leads, unfortunately, to a lot of preventable deaths and hospitalizations that could have been avoided if we had timely initiation of evidence-based therapy, like an SGLT2 inhibitor.”
“However, compared to the earlier time periods, we did not observe substantial improvement in guideline-recommended SGLT2-inhibitor prescription rates in patients with diabetes, and SGLT2-inhibitor prescription rates were similar regardless of presence or absence of a class 1a recommendation. We were struck by this lack of improvement and adherence to the guidelines in the diabetes population.”
“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.”
Low SGLT2-inhibitor use persists among class 1A–eligible patients; leaves open whether targeted implementation efforts can close this gap.
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.
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Shin et al. (2024) conducted a cross-sectional in Class 1A indications for SGLT2-inhibitors (Diabetes, Heart Failure, CKD, ASCVD) (n=3,189,827). Class 1A recommendation for SGLT2-inhibitor therapy vs. Absence of a class 1A recommendation for SGLT2-inhibitor therapy was evaluated on SGLT2-inhibitor prescription rate in patients with diabetes (SMD 1.3%). SGLT2-inhibitor prescription rates were extremely low among patients with a class 1A recommendation, at 11.9% in those with diabetes and 3.1% in those without diabetes.
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