Introduction: Endocrinologists, cardiologists, and nephrologists commonly care for people with diabetes and coexisting cardiovascular disease (CVD), heart failure (HF), and chronic kidney disease (CKD). Guidelines recommend that GLP-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors (SGLT2i) be prescribed in this context, but they remain broadly underutilized particularly among older adults.
Methods: In this retrospective cohort study using 100% sample of 2019 Medicare fee-for-service claims linked to American Board of Internal Medicine data files, we calculated the proportions of pharmacologically treated patients ≥66 years with diabetes and CVD, HF, or CKD treated by endocrinologist, nephrologist, or cardiologist and subsequently filled GLP-1RA or SGLT2i prescribed by one of these specialists. We used logistic regression to quantify associations with GLP-1RA/SGLT2i prescribing and both patient and physician characteristics.
Results: We identified 402,922/ 330,003/ 638,408 pharmacologically treated patients seen by 5,338/ 8,059/ 10,761 endocrinologists/ nephrologists/ cardiologists, respectively. Most endocrinologists prescribed diabetes drugs to their patients (73.7%) while nephrologists and cardiologists rarely did (6.3% and 4.0% respectively). Among patients they prescribed to, just 12.2% of nephrologist-, 13.9% of cardiologist-, and 26.6% of endocrinologist-treated patients filled a GLP-1RA or SGLT2i prescription prescribed by that specialist. Across specialties, GLP-1RA or SGLT2i use were lowest for older patients (10-25 percentage points less for ≥85 vs 66-69 year olds). Differences were also observed by race, dual Medicare/Medicaid eligibility, and physician age.
Conclusion: Nephrologists and cardiologists caring for people with diabetes rarely prescribed GLP-1RA and SGTL2i to patients who would benefit from them and may benefit from additional training and support to prescribe them, particularly to older adults.
R.G. McCoy: Research Support; American Diabetes Association. Other Relationship; American Diabetes Association. Consultant; Wolters Kluwer Health. Research Support; National Institutes of Health, Patient-Centered Outcomes Research Institute. Consultant; Yale New Haven Health System. J.L. Vandergrift: Employee; American Board of Internal Medicine. B.M. Gray: None.
