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Patterns of Prescribing Sodium-Glucose Cotransporter-2 Inhibitors for Medicare Beneficiaries in the United States
- Source :
- Circ Cardiovasc Qual Outcomes
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Background: Evidence from large randomized clinical trials supports the benefit of SGLT2i (sodium-glucose cotransporter-2 inhibitors) to improve cardiovascular and kidney outcomes in patients with type 2 diabetes with or at high risk for atherosclerotic cardiovascular disease or chronic kidney disease. Considering this evidence, which has been expanding since the product label indication for empagliflozin to reduce risk of cardiovascular death in 2016, clinician-level variation in the prescription of SGLT2i among US Medicare beneficiaries was evaluated. Methods: Antihyperglycemic medication prescribers were identified as those physicians and advanced practice providers prescribing metformin in Medicare part D prescriber data. In this cross-sectional study, the proportion prescribing SGLT2i was assessed overall and across specialties in 2018, with changes assessed from 2014 to 2018. SGLT2i use was compared with other second-line antihyperglycemic medication classes, sulfonylureas and DPP4is (dipeptidyl peptidase-4 inhibitors). Results: Among 232 523 unique clinicians who prescribed metformin for Medicare beneficiaries in 2018 (diabetes-treating clinicians), 45 255 (19.5%) prescribed SGLT2i. There was substantial variation across specialties—from 72% of endocrinologists to 14% of cardiologists who prescribed metformin also prescribed SGLT2i. Between 2014 and 2018, the number prescribing SGLT2i increased 5-fold from 9048 in 2014 to 45 255 in 2018. Among clinicians who prescribed both sulfonylureas and SGLT2i in 2018, SGLT2i was prescribed to a median 33 beneficiaries for every 100 prescribed sulfonylureas (interquartile range, 18–67). SGLT2i use relative to sulfonylureas increased from 19 (interquartile range, 11–34) per 100 in 2014 to 33 (interquartile range, 18–67) per 100 in 2018 ( P trend Conclusions: Eighty percent of clinicians prescribing metformin to Medicare beneficiaries did not prescribe SGLT2i in 2018. Moreover, sulfonylureas prescriptions were 3 times more frequent than those of SGLT2is, although a pattern of increasing uptake may portend future trends. These findings highlight a baseline opportunity to improve care and outcomes for patients with type 2 diabetes.
- Subjects :
- medicine.medical_specialty
MEDLINE
Medicare
Article
law.invention
Randomized controlled trial
law
Internal medicine
medicine
Empagliflozin
Humans
Hypoglycemic Agents
Medicare Part D
Medical prescription
Sodium-Glucose Transporter 2 Inhibitors
Aged
business.industry
Sodium
Type 2 Diabetes Mellitus
medicine.disease
United States
Metformin
Cross-Sectional Studies
Glucose
Diabetes Mellitus, Type 2
Cardiology and Cardiovascular Medicine
business
Kidney disease
medicine.drug
Subjects
Details
- ISSN :
- 19417705 and 19417713
- Volume :
- 14
- Database :
- OpenAIRE
- Journal :
- Circulation: Cardiovascular Quality and Outcomes
- Accession number :
- edsair.doi.dedup.....81f89d247635387b984f8aa7be6ee006