The SGLT2 Inhibitor Visual Tour: Bringing Visuals to Increase Prescribing for CKD Plus Type 2 Diabetes Mellitus (T2DM)

Background: Chronic kidney disease (CKD) is growing in prevalence in the US, and the importance of controlling proteinuria in patients with CKD due to diabetes cannot be overstated. Multiple studies have shown that sodium glucose cotransporter 2 inhibitors (SGLT2i) reduce proteinuria and slow progression of proteinuric CKD. Here, we present a visual aid system that helped increase physician prescribing of SGLT2i to those with clinical indications. Methods: This quality improvement initiative was conducted in an urban CKD specialty clinic in Atlanta, Georgia. Baseline data over the span of 6 weeks was collected to determine the utilization of SGLT2i in patients who met criteria, which included all patients with type 2 diabetes mellitus (T2DM) who had GFR ≥ 20 mL/min/1.73m2 - ≤ 75 mL/min/1.73m2 and urine microalbumin: creatinine ratio ≥ 200 mg/g. Then, a visual aid reminder for physicians that included a large informational poster listing the above criteria was posted in the main physician workroom, and an educational session on indications for prescribing SGLT2i was conducted for providers. Two weeks of post-intervention data was collected to assess utilization of SGLT2i. Results: There were 360 patient encounters conducted by 16 physicians that were reviewed in the pre-intervention phase. Out of these, 111 patients met the criteria for prescribing SGLT2i, of which 63% were prescribed or already taking an SGLT2i. Common reasons for deferring SGLT2i were the history of UTI or yeast infections. In the post-intervention phase, 83 encounters were reviewed, of which 41 patients met indications for SGLT2i and 73% of those were prescribed an SGLT2i. Conclusion: Despite numerous studies showing the efficacy of SGLT2i in reducing proteinuria, more than one third of the patients in our CKD clinic were not on one despite meeting the indications. This highlights the importance of both provider education and an augmenting visual aid system to positively impact prescribing practices for SGLT2i among eligible CKD patients. These interventions demonstrated preliminary efficacy in our clinic. Continual reinforcement and patient-directed educational resources may also further the efficacy of these measures. Additional interventions might be necessary to achieve enhancements in adhering to guidelines for prescribing and optimizing care for this vulnerable patient group.