Authors: Sydney L. Robbins, Jodi M. Grandominico, Neeraj H. Tayal, Lauren A. Kirk, Cory P. Coffey
Journal: Researchers’ Journal of Internal Medicine
DOI: pending
Publication Date: 2025/11/01
Background
The 2022 KDIGO guidelines now recommend the initiation of sodium glucose-cotransporter 2 inhibitors (SGLT2i) in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) with an eGFR > 20 mL/min/1.73m2 to slow the progression of kidney dysfunction. Despite updated standard of care recommendations, the uptake of SGLT2is in eligible patients is suboptimal.
Objective
This research aimed to observe the prescribing patterns of SGLT2is by primary care resident physicians in eligible patients with T2D and CKD G3a/3b.
Methods
This study utilized a data analytics platform to identify adults with CKD G3a/G3b and T2D at two primary care clinics, comprised of more than 100 resident physicians between July 1st, 2023, and October 31st, 2023. The primary objective of this study was to identify the proportion of patients currently prescribed an SGLT2i. Secondary objectives included identifying the proportion of patients: (1) never prescribed an SGLT2i, (2) previously prescribed a SGLT2i but not currently on therapy, and (3) not currently on SGLT2i therapy but may qualify for initiation based on current clinical practice guidelines
Results
A total of 240 patients were identified with CKD G3a/G3b and T2D. 111/240 (46.2%) were removed from the primary care resident cohort due to eGFR values falling outside the CKD G3a/G3b criteria at the time of review. 12/240 (5%) were not observed as they have not seen their primary care resident physician in more than 12 months. 46/240 (19.2%) were observed in the specialist cohort as they were managed by endocrinology or nephrology. This left 71/240 (29.6%) patients observed in the primary care resident physician cohort for SGT2i use. Among these, 27/71 (38%) were currently prescribed an SGLT2i, while 44/71 (62%) were identified as potential candidates for therapy initiation.
Conclusion
This analysis describes the underutilization of SGLT2is in eligible patients, despite updated standard of care recommendations and evidence to support its benefit.