Sodium‐glucose co‐transporter‐2 inhibitors in patients with type 2 diabetes: Barriers and solutions for improving uptake in routine clinical practice

Abstract

Recent advances in type 2 diabetes (T2D) research have highlighted the benefits of sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors, including cardiovascular and renal protection. However, uptake rates of these drugs remain low in patients with T2D, particularly in subpopulations most likely to benefit from them. This review considers the potential barriers to prescribing SGLT‐2 inhibitors in T2D in clinical practice and outlines potential multidisciplinary recommendations to overcome these barriers. Safety concerns and a lack of clarity in and divergence of guidelines around the introduction of SGLT‐2 inhibitors into treatment regimens may represent a barrier to uptake from the clinicians' perspective, including a general lack of understanding of the benefits associated with SGLT‐2 inhibitors. Patient characteristics, such as socioeconomic status, may influence uptake because of the cost of SGLT‐2 inhibitors, especially in the United States, where health insurance coverage could be a concern. SGLT‐2 inhibitor prescription rates vary between clinical specialty (endocrinology, primary care, cardiology, and nephrology) and country, with cardiologists the lowest prescribers, and endocrinologists the highest. Primary care practitioners may experience more challenges in following SGLT‐2 inhibitor‐related guidelines than diabetes specialists as there may be fewer opportunities for education on how this drug class improves cardiovascular and renal outcomes in patients with T2D. Uptake rates appear to vary between countries because of differences in guidelines and health insurance systems. The amendment of SGLT‐2 inhibitor‐related guidelines for more multidisciplinary use and the implementation of patient and clinician education may encourage uptake of these drugs, potentially improving long‐term health outcomes among patients with T2D.

Clinical Profile and Management of Patient Patients with Ischemic Heart Disease and/or Peripheral Artery Disease in Clinical Practice: The APALUSA Study

“…In fact, our study showed that the modification of antidiabetic treatment in this population was insufficient. Despite the benefits that these drugs have demonstrated in clinical trials, their use in clinical practice remains markedly low [ 37 , 38 ].…”

SGLT2 inhibitors and AMPK: The road to cellular housekeeping?

“…Urogenital infections are the most frequently observed but often manageable harmful consequence of consuming SGLT2i. 1,2 In clinical cases, similar effects of inhibitors on the function of proteins and receptors in the body are observed, which have beneficial effects. 3 SGLT2i have demonstrated the ability to decrease major adverse cardiovascular events (MACE) and hospitalization for heart failure.…”

“…According to studies, SGLT2i may help kidney function, blood pressure, and heart health and minimize the chances of hospitalization and mortality in patients who already have these illnesses. Urogenital infections are the most frequently observed but often manageable harmful consequence of consuming SGLT2i 1,2 . In clinical cases, similar effects of inhibitors on the function of proteins and receptors in the body are observed, which have beneficial effects 3 .…”

The prescribing pattern of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in patient with type two diabetes mellitus: A two-center retrospective cross-sectional study

“…Despite the proven cardiorenal benefits and weightreduction effects of SGLT2i and GLP-1 RA in patients with T2DM, along with the guidelines that recommend their use, their application in practice remains limited (18)(19)(20). Several studies have reported that the rate of using SGLT2i or GLP-1 RA among patients with T2DM and at high risk of or with established ASCVD or CVD ranges from 4.1 to 19% (18,20,21).…”

“…The underutilization of these medications may be attributed to the older age of these patients, as well as the increased number of comorbidities, costs, and formulary barriers (18,22). Other factors that limit the use of SGLT2i and GLP-1 RA may be related to the prescriber's specialty, concerns about the safety of these medications, or the need for prior authorization (19,23).…”