Department of Internal Medicine, Sejong Hospital, Bucheon, Korea.
Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
BMC Nephrol. 2021 May 14;22(1):177. doi: 10.1186/s12882-021-02381-3.
Sodium-glucose cotransporter 2 inhibitor (SGLT2i) should be considered for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) having estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m and urine albumin-to-creatinine ratio (UACR) > 30 mg/g. However, SGLT2i is currently underprescribed among eligible, at-risk patients for CKD progression. We analyzed prescription patterns and barriers to initiating SGLT2i in patients with T2D and CKD in real practice.
A total of 3,703 consecutive outpatients with T2D from four teaching hospitals during six months (2019 ~ 2020) were reviewed. Five eGFR categories (G1, ≥ 90; G2, 60-89; G3ab, 30-59; G4-5, < 30 mL/min/1.73 m) and three UACR categories (A1, < 30; A2, 30-300; A3, > 300 mg/g) were used to define CKD status.
Overall, 25.8 % patients received SGLT2i in the following eGFR and albuminuria categories: G1 (A1, 31 %; A2, 48 %; A3, 45 %); G2 (A1, 18 %; A2, 24 %; A3, 30%); and G3 (A1, 9 %; A2, 7 %; A3, 13 %). Total prevalence estimate of CKD was 33.8 % (n = 1,253), of whom 25.6 % patients received SGLT2i. We defined eGFR ≥ 45 mL/min/1.73 m and UACR ≥ 30 mg/g as high-risk CKD group eligible for SGLT2i (n = 905), of whom 32.9 % patients were treated with an SGLT2i. In this high-risk group, SGLT2i initiation showed negative correlations with age ≥ 65 years and recent hospitalization. Conversely, HbA1c level, body mass index (BMI), presence of diabetic retinopathy, and previous heart failure events were positively correlated with SGLT2i initiation.
Only 32.9 % of T2D with CKD eligible for SGLT2i is currently treated with SGLT2i in real-world clinical practice. The older patient group and clinical inertia are the main barriers to initiate SGLT2i for eligible patients. Clinicians should change the glucocentric approach and focus on reducing renal events in T2D.
钠-葡萄糖共转运蛋白 2 抑制剂 (SGLT2i) 应考虑用于估计肾小球滤过率 (eGFR) ≥30 mL/min/1.73 m 且尿白蛋白与肌酐比值 (UACR) >30 mg/g 的 2 型糖尿病 (T2D) 和慢性肾脏病 (CKD) 患者。然而，在有进展为 CKD 风险的合格患者中，SGLT2i 的处方率目前较低。我们分析了在真实实践中 T2D 和 CKD 患者中开始使用 SGLT2i 的处方模式和障碍。
在六个月期间（2019 年至 2020 年），对来自四所教学医院的 3703 名连续 T2D 门诊患者进行了回顾性分析。使用五个 eGFR 类别（G1，≥90；G2，60-89；G3ab，30-59；G4-5，<30 mL/min/1.73 m）和三个 UACR 类别（A1，<30；A2，30-300；A3，>300 mg/g）来定义 CKD 状态。
总体而言，25.8%的患者在以下 eGFR 和白蛋白尿类别中接受了 SGLT2i：G1（A1，31%；A2，48%；A3，45%）；G2（A1，18%；A2，24%；A3，30%）；和 G3（A1，9%；A2，7%；A3，13%）。CKD 的总患病率估计为 33.8%（n=1,253），其中 25.6%的患者接受了 SGLT2i。我们将 eGFR≥45 mL/min/1.73 m 和 UACR≥30 mg/g 定义为适合 SGLT2i 的高风险 CKD 组（n=905），其中 32.9%的患者接受了 SGLT2i 治疗。在这个高风险组中，SGLT2i 的起始与年龄≥65 岁和最近住院呈负相关。相反，HbA1c 水平、体重指数 (BMI)、存在糖尿病视网膜病变和既往心力衰竭事件与 SGLT2i 的起始呈正相关。
在真实世界的临床实践中，只有 32.9%的符合 SGLT2i 适应证的 T2D 合并 CKD 患者正在接受 SGLT2i 治疗。老年患者群体和临床惯性是导致符合条件的患者开始使用 SGLT2i 的主要障碍。临床医生应改变以葡萄糖为中心的治疗方法，专注于降低 T2D 患者的肾脏事件风险。
