Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Medicine, Duke Clinical Research Institute, Center for Preventive Medicine, Duke University, Durham, NC.
Am Heart J. 2020 Jun;224:47-53. doi: 10.1016/j.ahj.2020.03.017. Epub 2020 Mar 20.
The adoption of 2 classes of new diabetes medications, glucagon-like peptide 1 receptor agonists (GLP1RA) and sodium-glucose co-transporter-2 inhibitors (SGLT2i), has been slow in the United States despite their cardiovascular benefits in addition to their glucose-lowering effect. The objective of this study was to identify providers' perspectives about prescribing GLP1RA and SGLT2i.
In this survey study, a questionnaire was administered between May 17, 2018, and June 11, 2018, in a large academic health care system. Ninety providers who practice in endocrinology, primary care, or cardiology responded the questionnaire, with a 36.3% response rate. The questionnaire explored knowledge, comfort level, beliefs, perceived barriers, and hypothetical clinical decisions about prescribing GLP1RA and SGLT2i.
Findings suggested a division of views from endocrinology and primary care providers versus cardiology providers. More than 88% of endocrinology providers and about 50% of primary care providers prescribed GLP1RA or SGLT2i at least 6 times a year, whereas less than 7% of cardiology providers prescribed either medication. All endocrinology providers, approximately 78% of primary care providers, and only 21% of cardiology providers were very comfortable or comfortable in all 4 knowledge aspects about GLP1RA and SGLT2i. Major barriers to prescribing GLP1RA and SGLT2i for endocrinology and primary care providers were cost and nonapproved prior authorizations, yet the top 3 reported barriers for cardiology providers were lack of knowledge about these medications, concerns of introducing confusion into diabetes care, and discomfort of prescribing diabetes medications.
Barriers to prescribing GLP1RA or SGLT2i are unique for endocrinology, primary care, and cardiology providers. Given the cardiovascular benefits of these medications, this study suggests specific areas and potential opportunities for clinicians to improve care for patients with diabetes and cardiovascular disease.
尽管胰高血糖素样肽 1 受体激动剂（GLP1RA）和钠-葡萄糖协同转运蛋白 2 抑制剂（SGLT2i）除了降低血糖外还有心血管益处，但这两类新型糖尿病药物在美国的采用速度一直很慢。本研究的目的是确定医生对开处 GLP1RA 和 SGLT2i 的看法。
在这项调查研究中，我们于 2018 年 5 月 17 日至 6 月 11 日在一家大型学术医疗保健系统中进行了问卷调查。90 名从事内分泌、初级保健或心脏病学的医生对问卷做出了回应，回应率为 36.3%。问卷探讨了他们在开处 GLP1RA 和 SGLT2i 方面的知识、舒适度、信念、感知障碍和假设临床决策。
研究结果表明，内分泌医生和初级保健医生与心脏病医生的观点存在分歧。超过 88%的内分泌医生和大约 50%的初级保健医生每年至少开 6 次 GLP1RA 或 SGLT2i，而不到 7%的心脏病医生开这两种药物。所有的内分泌医生、大约 78%的初级保健医生和只有 21%的心脏病医生在 GLP1RA 和 SGLT2i 的所有 4 个知识方面都非常舒适或舒适。对内分泌和初级保健医生开处 GLP1RA 和 SGLT2i 的主要障碍是费用和未经批准的预授权，而心脏病医生报告的前 3 个障碍是对这些药物缺乏了解、担心在糖尿病治疗中引入混淆，以及对开处糖尿病药物的不适。
对内分泌、初级保健和心脏病医生开处 GLP1RA 或 SGLT2i 的障碍是独特的。鉴于这些药物的心血管益处，本研究表明了具体的领域和潜在的机会，为临床医生改善患有糖尿病和心血管疾病患者的护理提供了方向。
