Prescribing practices and barriers to use of sodium‐glucose cotransporter 2 inhibitors and glucagon‐like Peptide‐1 receptor agonists in adult kidney transplant recipients: A survey of endocrinology and nephrology prescribers

Abstract

Clinical practice variability exists regarding the use of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA) in kidney transplant recipients (KTRs). The objective of this study was to understand prescribing practices and barriers for the use of SGLT2i and GLP‐1RA among endocrinology and nephrology prescribers caring for KTRs. A 19‐item electronic survey assessing prescribing practices and barriers for the use of SGLT2i and GLP‐1RA in adult KTRs was distributed to all members of the Planning Research in Inpatient Diabetes/Planning Research in Outpatient Diabetes (PRIDE/PROUD) group and the American Society of Transplantation Kidney Pancreas Community of Practice via email listservs between July and November 2023. Endocrinology and nephrology prescribers caring for adult KTRs with type 2 diabetes mellitus (T2DM) or post‐transplant diabetes mellitus (PTDM) were eligible. A total of 50 responses were included for analysis (n = 25 endocrinology, n = 25 nephrology). Respondents prescribed SGLT2i and GLP‐1RA to adult KTRs with T2DM/PTDM with the following frequency: always (4% SGLT2i, 6% GLP‐1RA), often (34% SGLT2i, 30% GLP‐1RA), sometimes (34% SGLT2i, 36% GLP‐1RA), rarely (22% SGLT2i, 20% GLP‐1RA), or never (6% SGLT2i, 8% GLP‐1RA). The most common indication for both drug classes was diabetes mellitus (DM)/hyperglycemia (84% SGLT2i, 90% GLP‐1RA). Most prescribers felt comfortable initiating a SGLT2i (58%) or GLP‐1RA (62%) between 1 and 6 months post‐transplant. Prescribers were always or often concerned about infection (67%) with the use of SGLT2i and gastrointestinal intolerance (66%) with GLP‐1RA. Cost of treatment/insurance coverage/need for prior authorization and patient concern for drug cost was identified as being very likely or likely barriers for prescribing these drug classes post‐transplant (54% SGLT2i, 62% GLP‐1RA). SGLT2i and GLP‐1RA are prescribed mainly for DM/hyperglycemia by endocrinology and nephrology prescribers between 1 and 6 months postkidney transplant. Concerns surrounding medication access and cost were the most frequently reported barriers to use.