Prevalence of <scp>SGLT2</scp> inhibitor and <scp>GLP1</scp> receptor agonist prescriptions in type 2 diabetes patients with and without chronic kidney disease: Analysis of an Australian primary care dataset
Hannah Wallace, James Wick, Brendon L. Neuen, Luke Buizen, Sunil V. Badve, John Chalmers, Juliana de Oliveira Costa, Michael O. Falster, Jeffrey T. Ha, Meg Jardine, Daniel Bekele Ketema, Jialing Lin, Craig Nelson, Sallie‐Anne Pearson, David Peiris, Anthony Rodgers, Takaya Sasaki, Mark Woodward, Martin Gallagher, Sradha Kotwal, Paul E. Ronksley, Min Jun
Abstract
Abstract Aims Sodium‐glucose co‐transporter 2 inhibitors (SGLT2 inhibitors) and glucagon‐like peptide‐1 receptor agonists (GLP1‐RA) have cardio‐kidney‐metabolic benefit. This study aimed to understand the prevalence of prescription of SGLT2 inhibitors and GLP1‐RA among patients with T2DM with and without chronic kidney disease (CKD) in Australian primary care. Materials and Methods We conducted a retrospective, cohort study of adults with T2DM who attended primary care practices participating in MedicineInsight. The outcome of interest was the percentage of patients with CKD who received ≥1 prescription for an SGLT2 inhibitor or a GLP1‐RA (assessed separately) compared to those without CKD during 2020–2021. We also assessed prescriptions in a sub‐population of CKD patients who met trial inclusion criteria: SGLT2 inhibitor (estimated glomerular filtration rate [eGFR] ≥20 mL/min/1.73m 2 and urine albumin‐creatinine ratio [UACR] ≥22.6 mg/mmol) and GLP1‐RA (eGFR ≥50 to <75 mL/min/1.73m 2 and UACR >33.9 to <565 mg/mmol, or eGFR ≥25 to <50 mL/min/1.73m 2 and UACR >11.3 to <565 mg/mmol). Results Of 114 499 adults with T2DM, 36 840 (32.1%) also had CKD. SGLT2 inhibitors were prescribed in 13.6% of patients without CKD, 14.4% of patients with CKD and 17.8% of patients meeting the trial target population definition. Across these groups, GLP1‐RA were prescribed in 8.8%, 10.1% and 11.3% of patients, respectively. More advanced CKD stage and severely increased albuminuria were associated with a lower likelihood of SGLT2 inhibitor or GLP1‐RA being prescribed. Conclusion We observed low rates of SGLT2 inhibitor and GLP1‐RA prescriptions in patients with T2DM irrespective of CKD status. Strategies are needed to improve prescription rates, with a particular focus on patients with high kidney and cardiovascular risk.