SGLT2 inhibitors (SGLT2i) have demonstrated benefit in high risk populations, although clinical uptake is often delayed. We sought to assess prevalent use of SGLT2i in type 2 diabetes within our health system to inform future quality improvement (QI) initiatives. From Sep 2016 to Oct 2019 a total of 1481 patients were prescribed an SGLT2i, of which 65% had prior ASCVD or heart failure (HF). Of all patients with diabetes and a diagnosis of ASCVD or HF (N=8448), only 11% were prescribed an SGLT2i during this time. These patients were on average 59±10 years old, 46% female, 43% Hispanic (see Table for additional details). Prescribing services included Internal Medicine (55%), Cardiology (26%) and Endocrinology (13%); the large majority of these patients (45%) received charity care from the health system. Descriptively, Hispanics, those with commercial insurance and nephropathy were more likely to receive an SGLT2i, while Blacks, Medicare and presence of co-morbidities less likely.
In summary, the use of SGLT2i in a high-risk population remains low (11%), especially in certain groups, such as Blacks and Medicare recipients. In our system, cardiologists contribute substantially to targeted use of SGLT2i, which should be encouraged elsewhere. This baseline data will inform our QI strategy and efforts in increasing evidence-based use of SGLT2i across the health system while targeting identified delivery inequalities.
U. Gunasekaran: None. J.N. McNulty: None. I. Lingvay: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Janssen Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk A/S, Sanofi, TARGET PharmaSolutions, Valeritas, Inc. Other Relationship; Self; Novo Nordisk A/S. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Applied Therapeutics, Sanofi US.