Predictors, Disparities, and Facility-Level Variation: SGLT2 Inhibitor Prescription Among US Veterans With CKD.

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Sodium/glucose cotransporter 2 (SGLT2) inhibitors are recommended for type 2 diabetes mellitus (T2DM) in patients with chronic kidney disease (CKD) or atherosclerotic cardiovascular disease (ASCVD).
• Understanding prescription patterns and disparities is crucial for equitable care.

Purpose of the Study:

• To evaluate factors associated with SGLT2 inhibitor prescription.
• To assess disparities by race and sex in SGLT2 inhibitor use.
• To examine facility-level variation in SGLT2 inhibitor prescription patterns.

Main Methods:

• Retrospective cohort study of US veterans with T2DM, CKD, and ASCVD from 2020.
• Multivariable logistic regression analyzed associations of race and sex with SGLT2 inhibitor prescription.
• Facility-level variation quantified using median rate ratios (MRR).

Main Results:

• 11.5% of 174,443 eligible patients received an SGLT2 inhibitor.
• Lower prescription odds observed in Black patients (OR, 0.87) and women (OR, 0.59) compared to White patients and men, respectively.
• An unexplained 58% variation in SGLT2 inhibitor prescription between facilities (MRR, 1.58) was noted, independent of patient and facility characteristics.

Conclusions:

• SGLT2 inhibitor prescription rates are low among eligible US veterans.
• Significant disparities in SGLT2 inhibitor use exist based on race and sex.
• Substantial unexplained variation in prescription rates between facilities highlights a need to address inequities in SGLT2 inhibitor adoption.