Suboptimal Use of SGLT2 Inhibitors in Individuals With Diabetes and Heart Failure

Among individuals with type 2 diabetes and heart failure, the prescription rate of sodium-glucose cotransporter-2 (SGLT2) inhibitors is too low and tends to favor those who are young, have commercial insurance, and are White, according to study results presented at the 30th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists (ENVISION 2021).

This retrospective cohort review included 1340 individuals with type 2 diabetes and heart failure whose data were extracted using International Classification of Diseases, 10th Revision (ICD-10) codes. These data included demographic characteristics such as sex, age, and health insurance, along with clinical data such as glycated hemoglobin levels, type of SGLT2 inhibitor prescribed, and time to discontinuation of SGLT2 inhibitor treatment. The ICD-10 code recorded both before and after the initial dose provided information on known adverse events from SGLT2 inhibitors.

The researchers reported that 9.6% (n=129) of study participants who were eligible for an SGLT2 inhibitor prescription received one. Of those who filled their prescription, 42.9% (n=54) discontinued treatment. A higher likelihood of starting treatment with an SGLT2 inhibitor was associated with younger age (58.3 years for SGLT2 users vs 64.4 years in the total study population), having commercial insurance (42.6% vs 25.8%[MOU1] [KT2] ), and being White (36.4% vs 16.2%). Discontinuation rates did not differ significantly by race, age, gender, or insurance; those who discontinued SGLT2-inhibitor treatment did so after an average of 1.5 months. Complication rates did not differ between groups. Outcome markers such as body mass index, glycated hemoglobin level, kidney function, or left ventricular ejection fraction did not differ between groups. Those prescribed canagliflozin discontinued treatment more often than those prescribed other SGLT2 inhibitors (46.3% vs 8.3%, respectively.

The study researchers concluded that “[SGLT2 inhibitors] are underprescribed, reaching only 9.6% of the ideal patient population,” with those receiving prescriptions “more likely to be young and have commercial insurance.” “Adverse outcomes were not more likely in users before or after treatment and should not be a limiting factor for initiation/trial of SGLT2 inhibitors,” they concluded.

Reference

Kristan M, Kim Y, Nelson T, et al. SGLT-2 inhibitor prescribing patterns at tertiary care diabetes center for individuals with diabetes and heart failure. Poster presented at: 30th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists (ENVISION 2021); May 26-29, 2021; virtual.

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