Why the study?
Although SGLT2 inhibitors, semaglutide, and finerenone improve renal and cardiovascular outcomes in patients with T2D and CKD, real-world prescribing of these therapies required assessment.
What are the real-world prescribing rates of guideline-directed medical therapy (SGLT2 inhibitors, GLP-1 agonists, MRAs) at discharge in hospitalized patients with type 2 diabetes and chronic kidney disease?
What are the real-world prescribing rates of guideline-directed medical therapy (SGLT2 inhibitors, GLP-1 agonists, MRAs) at discharge in hospitalized patients with type 2 diabetes and chronic kidney disease?
Despite guideline recommendations, there is significant under-prescribing of evidence-based renal and cardiovascular protective therapies like SGLT2 inhibitors and GLP-1 agonists in hospitalized patients with T2D and CKD, though rates are improving over time.
Discharge prescribing of cardiorenal GDMT remains incomplete in T2D-CKD; leaves open barriers and hospital implementation strategies.
BACKGROUND: In patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), sodium-glucose cotransporter 2 (SGLT2) inhibitors, semaglutide (glucagon-like peptide-1 [GLP-1] agonist), and finerenone (non-steroidal mineralocorticoid receptor antagonist) improve renal and cardiovascular outcomes. We assessed real-world prescribing of these drugs in patients with T2D and CKD. METHOD: , acute kidney injury, renal transplant, or those receiving dialysis were excluded. Drugs prescribed at discharge were obtained. RESULTS: Of 2,216 patients (mean age 78.2±10.9 years and 41.3% female), an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker was prescribed in 1,243 (56.1%) patients, an SGLT2 inhibitor in 472 (21.3%), a GLP-1 agonist in 163 (7.4%), and a mineralocorticoid receptor antagonist in 305 (13.8%). Specifically, semaglutide was prescribed in 79 (3.6%) patients and finerenone in three (0.1%). Overall, 735 (33.2%) patients were prescribed none, 919 (41.5%) one, 433 (19.5%) two, 115 (5.2%) three, and 14 (0.6%) all four drug groups. From January to March 2020 to July to September 2024, there was an increased prescribing of SGLT2 inhibitors (7.9%-38.7%; p<0.001) and GLP-1 agonists (6.3%-11.7%; p=0.007). CONCLUSIONS: In patients admitted to the hospital with T2D and CKD, one-quarter were prescribed an SGLT2 inhibitor and/or a GLP-1 agonist at discharge. Further studies are required to identify barriers and enablers to prescribing these drugs.
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Lan et al. (2025) studied this question.
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