ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1016

SGLT2i Prescribing for Type 2 Diabetes and Comorbid Conditions Among 24 US Healthcare Organizations

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Stempniewicz, Nikita, AMGA (American Medical Group Association), Alexandria, Virginia, United States
  • Rattelman, Cori, AMGA (American Medical Group Association), Alexandria, Virginia, United States
  • Kennedy, John W., AMGA (American Medical Group Association), Alexandria, Virginia, United States
  • Ciemins, Elizabeth, AMGA (American Medical Group Association), Alexandria, Virginia, United States
  • Cuddeback, John K., AMGA (American Medical Group Association), Alexandria, Virginia, United States
  • Sang, Yingying, Johns Hopkins University, Baltimore, Maryland, United States
  • Coresh, Josef, Johns Hopkins University, Baltimore, Maryland, United States
  • Grams, Morgan, Johns Hopkins University, Baltimore, Maryland, United States
  • Shin, Jung-Im, Johns Hopkins University, Baltimore, Maryland, United States
Background

Sodium glucose cotransporter-2 inhibitors (SGLT2i) are among several glucose-lowering therapies available. Clinical guidelines for type 2 diabetes recommend use of SGLT2i for people with ASCVD, heart failure (HF), or CKD when eGFR is adequate, to control glycemia, reduce cardiovascular risk, and slow progression of kidney disease.

Methods

Using an EHR-derived dataset from 24 AMGA member health care organizations (HCOs), we identified 248,469 patients with type 2 diabetes aged 18–85 who had ≥1 ambulatory encounter with a primary care provider and ≥1 prescription for a glucose-lowering medication other than metformin and insulin in the past year (9/2018–8/2019). Patients with end stage kidney disease or hospice care were excluded. We explored the proportion of patients with an SGLT2i prescribed in the past year, and used logistic regression to describe differences by eGFR category, comorbid conditions, and specialist visits, adjusted for all predictor variables, age, sex, race, ethnicity, financial class, and HCO.

Results

Across HCOs, median proportion of patients with an SGLT2i prescribed was 22% (range, 12–39%). Prescribing decreased with eGFR category from G1 to G4 (Figure 1). SGLT2i prescribing was lower for patients with HF and those who saw a nephrologist, marginally higher for patients with ASCVD and those who saw a cardiologist, and substantially higher for patients who saw an endocrinologist.

Conclusion

There was significant variation in SGLT2i prescribing across HCOs. While guidelines emphasize use of SGLT2is among patients with ASCVD, HF, or CKD, our findings suggest these recommendations have not been widely adopted in clinical practice. Endocrinologists may play an important role in prescribing new glucose-lowering medications, while nephrologists may be hesitant to prescribe medications for type 2 diabetes.