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Abstract: SA-PO267

Perceived Barriers to SGLT2i Prescription in Primary Care vs. Nephrology Providers: Findings From the Michigan Kidney Improvement Collaborative

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical


  • Heung, Michael, University of Michigan, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
  • Wright Nunes, Julie A., University of Michigan, Ann Arbor, Michigan, United States
  • Reiss, Jacob E., University of Michigan, Ann Arbor, Michigan, United States
  • Khosrovaneh, Katherine Lisa, University of Michigan, Ann Arbor, Michigan, United States
  • Rau, Jacqueline, University of Michigan, Ann Arbor, Michigan, United States

Group or Team Name

  • Michigan Kidney Improvement Collaborative

Newer medications such as SGLT2i’s and GLP1a’s reduce cardiovascular, renal, and metabolic complications in patients with type 2 diabetes, yet studies suggest slow uptake in prescribing among eligible populations. Here we report initial findings from the Michigan Kidney Improvement Collaborative (MKIC), a state-wide nephrology initiative launched in 2021 to improve care of diabetic kidney disease. MKIC is embedded within the Michigan Collaborative for Type 2 Diabetes (MCT2D) which focuses on primary care physicians (PCPs).


11 nephrology practices (37% of all Michigan nephrologists) and 238 PCP practices were recruited. An initial joint MKIC/MCT2D goal is to increase use of SGLT2i’s and GLP-1a’s. To assist in these efforts, a baseline practice readiness assessment survey was completed to identify barriers to SGLT2i and GLP1a prescribing.


Nephrology practices had more experience prescribing SGLT2i’s than GLP1a’s (73% vs 27%). Despite this, 73% of nephrology practices responded that they were “Very” or “Mostly” confident about implementing measures to improve prescribing of these medications, similar to the response from PCPs (68%, p=0.70). More PCP than nephrology practices worked with an affiliated pharmacist (33% vs 18%, p=0.355). Differences in perceived barriers to prescribing are shown in the Table. Both nephrology and PCP practices had high level of concerns related to cost and insurance coverage. However, PCP practices identified greater educational needs and higher concern about patient acceptance of injections.


PCPs and nephrologists perceive different barriers to increasing usage of newer diabetes medications and may have differential access to resources. Population health-based strategies to promote uptake of these medications need to be tailored to the specific audience. Initial such efforts by MKIC/MCT2D have been well-received, and subsequent analyses will assess impact on medication prescription rates.

Perceived BarrierNephrology Practice (n=11)Primary Care Practice (n=196)p-value
Cost of medication7 (64%)174 (89%)0.63
Insurance coverage challenges11 (100%)163 (83%)0.83
Patient injectable hesitancy1 (9%)83 (42%)0.19
Insufficient provider knowledge regarding medications0117 (60%)<0.001