‘We are somehow fixated on this being a diabetes drug’: a qualitative study exploring the views of cardiologists and nephrologists about sodium‐glucose cotransporter 2 inhibitor initiation

Milder, Tamara Y.; Stocker, Sophie L.; Baysari, Melissa T.; Day, Richard O.; Greenfield, Jerry R.

doi:10.1111/imj.16203

Cited by 2 publications

(1 citation statement)

References 40 publications

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“…In addition, given the diverse patients seen in primary care, adherence to guidelines for every patient problem is hardly feasible [91]. Admittedly, especially with the SGLT2 inhibitors, nonspecialists are less confident in the use of these medications and worry about side-effects, lack of time for the necessary followup, or may view them more for non-kidney indications [92]. Clinicians may also hesitate because of unaffordability for patients.…”

Section: Health Care Professionalsmentioning

confidence: 99%

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Luyckx,

Elmaghrabi,

Sahay

et al. 2023

Am J Nephrol

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Background: Chronic kidney disease (CKD) is an important but insufficiently recognized public health problem. Unprecedented advances in delaying progression of CKD and reducing kidney failure and death have been made in recent years, with the addition of the sodium glucose co-transporter 2 inhibitors and other newer medication to the established standard of care with inhibitors of the renin angiotensin system. Despite knowledge of these effective therapies, their prescription and use remains suboptimal globally, and more specially in low resource settings. Many challenges contribute to this gap between knowledge and translation into clinical care, which is even wider in lower resource settings across the globe. Implementation of guideline-directed care is hampered by lack of disease awareness, late or missed diagnosis, clinical inertia, poor quality care, cost of therapy, systemic biases, and lack of patient empowerment. All of these are exacerbated by the social determinants of health and global inequities. Summary CKD is a highly manageable condition but requires equitable and sustainable access to quality care supported by health policies, health financing, patient and healthcare worker education and affordability of medications and diagnostics. Key Messages The gap between the knowledge and tools to treat CKD and the implementation of optimal quality kidney care should no longer be tolerated. Advocacy, research and action are required to improve equitable access to sustainable quality care for CKD everywhere.

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Section: Health Care Professionalsmentioning

confidence: 99%

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Luyckx,

Elmaghrabi,

Sahay

et al. 2023

Am J Nephrol

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Use of, time to, and type of first add‐on anti‐hyperglycaemic therapy to metformin in Australia, 2018–2022

Milder,

Lin,

Pearson

et al. 2024

Brit J Clinical Pharma

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AimsThe aim of this study was to examine contemporary trends in the use of, time to, and type of first add‐on anti‐hyperglycaemic therapy to metformin in Australia.MethodsWe used the dispensing records of a 10% random sample of Pharmaceutical Benefits Scheme (PBS) eligible people. We included people aged 40 years and older initiating metformin from 1 January 2018 to 31 December 2020. Our primary outcome was first add‐on anti‐hyperglycaemic medicine within 2 years of metformin initiation. We analysed time to dispensing of first add‐on therapy. All analyses were stratified by metformin initiation year.ResultsOverall, 38 747 people aged 40 years and older initiated metformin between 2018 and 2020. Approximately one‐third (n = 12 946) of people received add‐on therapy with the proportion increasing slightly by year of metformin initiation (32.3% in 2018 to 34.8% in 2020). Amongst people with add‐on therapy following metformin initiation, sodium‐glucose cotransporter 2 inhibitor (SGLT2i) use increased from 28.8% (2018) to 35.0% (2020), and glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA) increased from 3.0% to 9.6%, respectively. Dipeptidyl peptidase‐4 inhibitors and sulfonylureas as first add‐on therapy decreased and insulin remained stable. One‐third of people with add‐on therapy initiated the therapy on the same day metformin was initiated, i.e. initial combination therapy.ConclusionsAmongst people initiating metformin from 2018 to 2020, there was an increasing proportion of SGLT2i and GLP‐1 RA being used as first add‐on therapy. However, the overall prevalence of add‐on therapy was low. Advocacy to promote add‐on therapy with cardiorenal beneficial medicines is critical to reduce type 2 diabetes morbidity and mortality.

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‘We are somehow fixated on this being a diabetes drug’: a qualitative study exploring the views of cardiologists and nephrologists about sodium‐glucose cotransporter 2 inhibitor initiation

Cited by 2 publications

References 40 publications

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Use of, time to, and type of first add‐on anti‐hyperglycaemic therapy to metformin in Australia, 2018–2022

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