SGLT2 Inhibitor Prescribing Practices in a Large Health System

Background: Sodium-glucose transport protein 2 (SGLT2) inhibitors are a class of medication that act on the renal proximal convoluted tubules to reduce the reabsorption of glucose. They were primarily used in diabetics to assist with glucose control and are now approved for the treatment of heart failure and chronic kidney disease (CKD). Once started on SGLT2 inhibitors, patients must be monitored for a decline in renal function especially if they are also put on angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and/or diuretics, as they can lead to decreases in kidney function and dehydration/hypotension. Methods: This is a retrospective cohort study of patients who were prescribed SGLT2 inhibitors in the Jefferson Health System. Data was sourced from the electronic medical record (EMR) using a customized query that returned the most recent 3 glomerular filtration rate (GFR) measurements, diagnostic codes, prescribed ACEi or ARB therapy, and prescribed diuretics. Results: Eleven thousand and eighteen adults with SGLT2 inhibitors in their medication lists were analyzed. Of these, 5956 (54.1%) patients had no GFR on record, 8744 (79.4%) were diagnosed with diabetes, 7152 (64.9%) were on concurrent ACEi/ARB therapy and 3579 (32.5%) were on diuretics. Conclusion: SGLT2 inhibitors have become the standard of care in patients with diabetes, CKD, cardiovascular disease, and heart failure. However, the proportion of patients in our study with CKD and heart failure was lower than expected, 6.9% and 1.9%, respectively. The concurrent use of ACEi/ARB medications and diuretics can be safe provided there is adequate monitoring of the fluid status and renal function. A substantial proportion (54.1%) of these patients do not have kidney function recorded in the EMR. This analysis highlights the need for improved clinical practices to ensure all patients are being safely monitored. - GFR > 60mL/min GFR < 60mL/min No GFR on record Diagnosed with heart failure Diagnosed with diabetes mellitus Prescribed ACEi/ARB Prescribed diuretic 4300 (39.0%) 762 (6.9%) 5956 (54.1%) 213 (1.9%) 8744 (79.4%) 7152 (64.9%) 3579 (32.5%)