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

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.