Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Graduate Department of Pharmaceutical Sciences, University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2023 Aug;71(8):2585-2592. doi: 10.1111/jgs.18360. Epub 2023 Apr 20.
Sodium-glucose cotransporter-2 inhibitor (SGLT2I) use has increased among community-dwelling populations, but little is known about how clinicians have prescribed them for US nursing home (NH) residents. We described the adoption of SGLT2Is by prescribers caring for long-stay NH residents by clinician specialty and over time, compared with sulfonylureas, an older diabetes medication class.
We conducted a retrospective cohort study of prescribers of SGLT2Is and sulfonylureas for all long-stay US NH residents aged 65 years or older (2017-2019). Using 100% of Medicare Part D claims linked to prescriber characteristics data, we identified all dispensings of SGLT2Is and sulfonylureas for long-stay NH residents and their associated prescribers. We described the distribution of prescriber specialties for each drug class over time as well as the number of NH residents prescribed SGLT2s versus sulfonylureas. We estimated the proportions of prescribers who prescribed both drug classes versus only sulfonylureas or only SGLT2Is.
We identified 36,427 unique prescribers (SGLT2I: N = 5811; sulfonylureas: N = 35,443) for 117,667 NH residents between 2017 and 2019. For both classes, family medicine and internal medicine physicians accounted for most prescriptions (75%-81%). Most clinicians (87%) prescribed only sulfonylureas, 2% prescribed SGLT2Is only, and 11% prescribed both. Geriatricians were least likely to prescribe only SGLT2Is. We observed an increase in the number of residents with SGLT2I use from n = 2344 in 2017 to n = 5748 in 2019.
Among NH residents, most clinicians have not incorporated SGLT2Is into their prescribing for diabetes, but the extent of use is increasing. Family medicine and internal medicine physicians prescribed the majority of diabetes medications for NH residents, and geriatricians were the least likely to prescribe only SGLT2Is. Future research should explore provider concerns regarding SGLT2I prescribing, particularly adverse events.
钠-葡萄糖共转运蛋白 2 抑制剂 (SGLT2I) 在社区居民中的使用有所增加，但对于临床医生如何为美国护理院 (NH) 居民开此类药物知之甚少。我们描述了临床医生根据专科和时间为长期 NH 居民开 SGLT2I 的情况，并与磺酰脲类药物（一种较老的糖尿病药物类别）进行了比较。
我们对所有 65 岁及以上长期居住在美国 NH 的 SGLT2I 和磺酰脲类药物的开处方者进行了回顾性队列研究。使用与处方者特征数据链接的 100%的医疗保险 Part D 理赔数据，我们确定了所有长期 NH 居民的 SGLT2I 和磺酰脲类药物的配药及其相关处方者。我们描述了每种药物类别在不同时期的处方者专业分布，以及开 SGLT2I 和磺酰脲类药物的 NH 居民人数。我们估计了同时开这两种药物类别的处方者比例，而不是仅开磺酰脲类药物或仅开 SGLT2I 的比例。
我们在 2017 年至 2019 年间确定了 36427 名独特的处方者（SGLT2I：N=5811；磺酰脲类：N=35443），用于 117667 名 NH 居民。对于这两种药物类别，家庭医学和内科医生的处方量最大（75%-81%）。大多数临床医生（87%）只开磺酰脲类药物，2%只开 SGLT2I，11%同时开这两种药物。老年病学家最不可能只开 SGLT2I。我们观察到 SGLT2I 使用者的数量从 2017 年的 2344 人增加到 2019 年的 5748 人。
在 NH 居民中，大多数临床医生尚未将 SGLT2I 纳入其糖尿病治疗处方，但使用量正在增加。家庭医学和内科医生为 NH 居民开了大多数糖尿病药物，而老年病学家最不可能只开 SGLT2I。未来的研究应探讨提供者对 SGLT2I 处方的担忧，特别是不良事件。
