Background: Though GLP1 receptor agonists (GLP1RA) and SGLT2 inhibitors (SGLT2i) decrease risk of cardiovascular and renal complications in DM2, uptake has been slow. The impact of specialist care and electronic consultation (e-consult) on prescribing of these medications is unknown.

Methods: We performed a case-control study to determine predictors for real-world prescription of GLP1RA and SGLT2i at an academic medical center. From 1/1/2017 to 8/19/2020, all patients with DM2 and known atherosclerotic cardiovascular disease (ASCVD) were identified. We randomly selected 177 patients with a current prescription for SLGT2i and/or GLP1RA, and 177 with no current or prior SGLT2i or GLP1RA use. Demographics, clinical characteristics, and healthcare utilization data were obtained.

Results: Patients with active SGLT2i and GLP1RA prescriptions were younger (66.5 vs. 70.7, p < 0.01), had higher BMI (31.8 vs. 28.8, p<0.01), higher A1c (8.3 vs. 7.0, p<0.01) and more likely male (56.5 % vs. 43.5 %, p <0.01). There were no differences in insurance type, language, patient portal enrollment, or diabetes complications severity index scores. Patients with current prescriptions were more likely to have either an endocrinology visit or e-consult (OR 5.6, p<0.01), and more likely to have an endocrinology e-consult alone (OR 2.4, p=0.03) as compared to patients without current prescriptions. Endocrinology (4.1 vs. 1.1, p< 0.01) and cardiology (3.1 vs. 2.1, p < 0.01) visits were higher among patients with active prescriptions, whereas the number of primary care and nephrology visits were similar in the two groups.

Conclusions: Although diabetes complications, including prior ASCVD, were similar between the two groups, patients prescribed SGLT2i or GLP1RA were more likely to have seen an endocrinologist or have had an endocrinology e-consult. Targeted, proactive outreach from endocrinologists to primary care providers via e-consults should be explored as a method to increase guideline-based prescribing of SGLT2i and GLP1RA.

Disclosure

A. Rasheed: None. T. Kompala: Consultant; Self; Eli Lilly and Company, Employee; Self; Livongo. A. B. Neinstein: Consultant; Self; Eli Lilly and Company, Intuity Medical , Medtronic, Roche Diabetes Care, Steady Health.

© 2021 by the American Diabetes Association
2021
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