<b>Factors Associated With Initiation of Sodium–Glucose Cotransporter 2 Inhibitor and Glucagon-Like Peptide 1 Receptor Agonists in Patients With Diabetes and Kidney Disease: A Post Hoc Analysis of the Kidney CHAMP Trial</b>

<p dir="ltr"><b>KEY POINTS</b></p><p dir="ltr">· The influence of social determinants of health (SDOH) on sodium–glucose cotransporter 2 (SGLT2) inhibitor and glucagon-like peptide 1 (GLP-1) receptor agonist prescribing for people with type 2 diabetes and chronic kidney disease (CKD) is not well known.</p><p dir="ltr">· This study found that younger age and higher A1C were associated with increased likelihood of initiation of SGLT2 inhibitors and GLP-1 receptor agonists. SDOH factors were not associated with initiation of these drugs. A CKD population health management intervention did not affect these associations.</p><p dir="ltr">· These findings suggest targets for new interventions to increase incident use of SGLT2 inhibitors and GLP-1 receptor agonists among individuals with type 2 diabetes and CKD.</p><p><br></p><p dir="ltr"><b>Objective.</b><b> </b>Negative social determinants of health (SDOH) are associated with greater kidney disease incidence and progression, partly because of suboptimal management. We studied the association of demographic, clinical, and individual- and contextual-level SDOH factors with sodium–glucose cotransporter 2 (SGLT2) inhibitor and glucagon-like peptide 1 (GLP-1) receptor agonist initiation in patients with type 2 diabetes and whether these associations were modified by the Kidney Coordinated HeAlth Management Partnership (K-CHAMP) population health management (PHM) program.</p><p dir="ltr"><b>Research Design and Methods.</b> Using data from the K-CHAMP trial, which cluster-randomized 101 primary care offices to a control arm or the PHM intervention (including nephology electronic consultation, chronic kidney disease education, and pharmacist medication review), we explored associations between SGLT2 inhibitor and GLP-1 receptor agonist initiation with a priori patient factors using adjusted Poisson regression. Enrolled patients with type 2 diabetes who were not prescribed an SGLT2 inhibitor or a GLP-1 receptor agonist at baseline were included. Effect modification by K-CHAMP was assessed using interaction terms.</p><p dir="ltr"><b>Results. </b>The cohort had 891 patients (402 receiving the PHM intervention and 489 in the control group). Fifty-five percent of participants were female and 89% were White; the cohort had had a mean age of 73 ± 9 years, mean BMI of 33 ± 7 kg/m<sup>2</sup>, mean A1C of 7.3 ± 1.5%, and mean estimated glomerular filtration rate of 37.4 ± 8.3 mL/min/1.73 m<sup>2</sup>; and 24% were rural living. Over a median follow-up of 17.7 months (interquartile range [IQR] 12.4–23.8 months), 238 (26.7%) initiated an SGLT2 inhibitor or GLP-1 receptor agonist. In adjusted analysis, age (incidence rate ratio [IRR] 0.92, 95% CI 0.85–0.99) and A1C (IRR 1.15, 95% CI 1.07–1.24) were significantly associated with SGLT2 inhibitor or GLP-1 receptor agonist initiation. The K-CHAMP PHM intervention did not significantly modify association of any factors.</p><p dir="ltr"><b>Conclusion. </b>Younger age and higher A1C were associated with increased likelihood of initiating<b> </b>an SGLT2 inhibitor or GLP-1 receptor agonist. Other demographic, clinical, and SDOH factors were not significantly associated with medication initiation. The K-CHAMP PHM intervention did not moderate the association of patient-level or SDOH factors with initiation of an SGLT2 inhibitor or GLP-1 receptor agonist.</p><p><br></p>