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Overcoming Disparities in Using SGLT2 Inhibitors for Cardiorenal Protection in Persons With and Without Type 2

Gwendolyne A Jack1, Eleonora Avenatti2, Sangeeta R Kashyap1

  • 1Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine-New York Presbyterian, New York, NY 10065, USA.

The Journal of Clinical Endocrinology and Metabolism
|May 27, 2025
PubMed

Insights

Sodium/glucose cotransporter 2 inhibitors (SGLT2i) show cardio-kidney benefits, yet disparities in use persist, especially in women and minority groups. Addressing these gaps is crucial for equitable patient outcomes in type 2 diabetes, heart, and kidney disease.

Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology

Background:

  • Sodium/glucose cotransporter 2 inhibitors (SGLT2i) offer significant cardio-kidney benefits for patients with type 2 diabetes (T2D), cardiovascular disease (CVD), and chronic kidney disease (CKD).
  • Despite established guidelines, substantial disparities exist in SGLT2i utilization, particularly affecting women, minority races, and lower socioeconomic status populations.
  • Underrepresentation of these demographic groups in clinical trials may contribute to suboptimal treatment patterns and poorer health outcomes.

Purpose of the Study:

  • To review and highlight existing disparities in SGLT2i use across populations with T2D, CKD, heart failure (HF), and atherosclerotic CVD (ASCVD).
  • To examine factors influencing SGLT2i prescription patterns and their impact on clinical outcomes.
  • To summarize strategies for improving SGLT2i adoption and other cardioprotective therapies in real-world settings.

Main Methods:

  • Literature review of clinical trials and observational studies focusing on SGLT2i use in T2D, CKD, HF, and ASCVD.
  • Analysis of factors contributing to prescribing disparities, including socioeconomic status, race, and gender.
  • Evaluation of strategies aimed at enhancing SGLT2i adoption and clinical outcomes.

Main Results:

  • Significant disparities in SGLT2i prescribing are evident across various patient demographics and disease states.
  • Underrepresentation in trials and socioeconomic factors contribute to inequitable access to SGLT2i.
  • Evidence suggests that targeted strategies can improve the adoption of SGLT2i and cardioprotective agents.

Conclusions:

  • Closing the gap between SGLT2i guidelines and real-world practice is essential to mitigate disparities.
  • Multifaceted approaches are needed to ensure equitable access to SGLT2i for all patients with T2D, CVD, and CKD.
  • Improving SGLT2i adoption can lead to better clinical outcomes and reduce morbidity and mortality rates.
Keywords:
SGLT2icardiovascular diseasechronic kidney diseasediabetes mellitusdisparities

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