한빛사논문
Jung-Im Shin MD, PhD a, Yunwen Xu PhD a, Alexander R. Chang MD, MS b, Juan J. Carrero PharmD, PhD c,d, Carina M. Flaherty BA e, Amrita Mukhopadhyay MD, MS f,g, Lesley A. Inker MD, MS h, Saul B. Blecker MD, MHS g,i, Leora I. Horwitz MD, MHS g,i, Morgan E. Grams MD, PhD a,e,g
aDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
bDepartments of Nephrology and Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
cDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
dDivision of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
eDivision of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
fDivision of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
gDepartment of Population Health, New York University Grossman School of Medicine, New York, New York, USA
hDivision of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts, USA
iDepartment of Medicine, New York University Grossman School of Medicine, New York, New York, USA
Address for correspondence: Dr Jung-Im Shin
Abstract
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce heart failure (HF) hospitalizations, recurrent cardiovascular events, and chronic kidney disease (CKD) progression, and thus constitute a Class 1a recommendation in people with diabetes and atherosclerotic cardiovascular disease, HF, or CKD and in people with severe albuminuria or HF, regardless of diabetes status.
Objectives: The purpose of this study was to comprehensibly characterize the rate of SGLT2 inhibitor prescriptions among people with a Class 1a recommendation for SGLT2 inhibitor use.
Methods: Among 3,189,827 adults from 28 U.S. health systems within Optum Labs Data Warehouse between April 1, 2022, and March 31, 2023, we assessed SGLT2 inhibitor prescription rates, stratified by presence of diabetes and Class 1a recommendation.
Results: Among 716,387 adults with diabetes, 63.4% had a Class 1a recommendation for SGLT2 inhibitor therapy. There was little difference by Class 1a recommendation status (present: 11.9%; 95% CI: 11.9%-12.0% vs absent: 11.4%; 95% CI: 11.3%-11.6%; standardized mean difference: 1.3%). Among 2,473,440 adults without diabetes, 6.2% had a Class 1a recommendation for SGLT2 inhibitor therapy, and 3.1% (3.0%-3.2%) of those received a prescription. Internists/family practitioners initiated SGLT2 inhibitor prescriptions most commonly among people with diabetes, whereas specialists initiated SGLT2 inhibitor prescriptions most commonly among people without diabetes. No health system had >25% SGLT2 inhibitor prescription rate among people with a Class 1a recommendation. Health systems with higher proportions of patients with commercial insurance and lower proportions with Medicare had higher SGLT2 inhibitor prescription rates.
Conclusions: In this analysis of U.S. data from 2022 to 2023, SGLT2 inhibitor prescription among people with a Class 1a recommendation is low. Interventions are needed to increase uptake of guideline-recommended SGLT2 inhibitor use.
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