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Data from a retrospective review of patients with type 2 diabetes and heart failure at a diabetes center in Maryland details trends in prescribing and discontinuation in a real-world setting over a 5-year period.
Data from a study conducted by clinicians at the University of Maryland School of Medicine is offering insight into trends of SGLT2 inhibitor prescribing in patients with diabetes and heart failure at medical centers in the US.
Presented at the American Academy of Clinical Endocrinology’s 30th Annual Meeting (AACE 2021), the retrospective chart review suggested fewer than 10% of eligible patients with type 2 diabetes and heart failure received a prescription for an agent within the class and also indicated rates of discontinuation were greater than 40% among those who initiated therapy with an SGLT2 inhibitor.
“Sodium-glucose cotransporter-2 inhibitors are under prescribed, reaching only 9.6% of the ideal patient population—those with diabetes mellitus and heart failure even in a tertiary care diabetes center of excellence,” wrote investigators.
Led by Megan Kristan, MD, a fellow in the Division of Endocrinology at the University of Maryland Medical Center, and a team of colleagues, the current study was designed with an interest in describing current trends in SGLT2 inhibitor prescribing among patients with type 2 diabetes and heart failure. For the purpose of analysis, investigators designed their study as a retrospective cohort review of patients treated at an academic tertiary center between January 1, 2015, and February 5, 2021.
For inclusion in the analysis, patients needed to be diagnosed with diabetes and congestive heart failure. Patients were excluded if they were missing data related to demographic information or clinic data such as type of SGLT2 inhibitor prescribed, A1c, and time to discontinuation.
In total, 1340 patients were identified by investigators for inclusion. This cohort had a mean age of 63.8±12.3 years, 55.2% were women, and 79.1% were non-Hispanic Black. Investigators also noted 27.5% of the cohort was commercially insured and 54.2% were insured through Medicare. Overall, just 129 (9.6%) of the 1340 patients were prescribed an SGLT2 inhibitor and, among these, 54 (42.9%) discontinued use during the study period.
When compared to those who did not receive a prescription, those who received a prescription for SGLT2 inhibitors were younger, more likely to have commercial insurance (42.6% vs 25.8%), and more likely to identify as non-Hispanic White (26.4% vs 16.2%). When assessing those who received a prescription for an SGLT2 inhibitor, results suggested the mean time to discontinuation was 1.5 months and those who were started on canagliflozin were more likely to discontinue than those prescribed to any other SGKT inhibitor (46.3% vs 8.3%).
Investigators noted there were no significant differences in discontinuation of SGLT2 inhibitor therapy based on demographic differences among patients included in the study. Investigators also pointed out no difference in adverse event rates was seen prior to or after beginning treatment with SGLT2 inhibitors.
“Those patients that were prescribed SGLT2 inhibitors were more likely to be young and have commercial insurance. A trend towards significance was seen with race, more commonly prescribed in White patients than those of racial/ethnic minorities. Attention to prescribing practices can help to minimize these differences,” wrote investigators.
This study, “SGLT-2 Inhibitor Prescribing Patterns at Tertiary Care Diabetes Center for Individuals with Diabetes and Heart Failure,” was presented at AACE 2021.