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Practice Variation in Prescribing SGLT2-Inhibitors: A Population-Based Analysis from Alberta, Canada.

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Prescriber factors, not patient characteristics, significantly influence the low uptake of sodium glucose-cotransporter 2 inhibitors (SGLT2is). Addressing prescriber variation is key to increasing SGLT2i use for cardiorenal benefits.

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Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Sodium glucose-cotransporter 2 inhibitors (SGLT2is) demonstrate significant cardiorenal protective benefits.
  • Real-world clinical adoption of SGLT2is remains suboptimal despite proven efficacy.
  • Understanding factors driving prescriber variation is crucial for improving SGLT2i utilization.

Purpose of the Study:

  • To investigate patient- and prescriber-level factors associated with SGLT2i prescription.
  • To quantify the extent of variation in SGLT2i prescribing behavior among clinicians.
  • To identify key physician groups influencing SGLT2i prescribing patterns.

Main Methods:

  • Population-based cohort study utilizing administrative data from Alberta, Canada (2014-2021).
  • Inclusion criteria: adults with a new oral antihyperglycemic medication prescription.
  • Multilevel logistic regression and median odds ratio used to analyze patient and prescriber characteristics and quantify prescriber-level variation.

Main Results:

  • A low rate of SGLT2i initiation was observed (0.8% of 339,314 patients).
  • SGLT2i prescribing was associated with male sex, younger age, obesity, and heart failure.
  • Prescriber factors demonstrated a greater impact on SGLT2i prescription (median odds ratio 3.55) than patient factors.
  • Cardiologists were significantly more likely to prescribe SGLT2is compared to family physicians (OR 13.5).

Conclusions:

  • The study highlights a low rate of SGLT2i initiation, primarily influenced by prescriber-level factors.
  • Substantial variation exists in SGLT2i prescribing, with specialists like cardiologists showing higher rates.
  • Family physicians, despite prescribing the majority of SGLT2is, represent a critical target for improving guideline-aligned prescribing practices.