我们似乎对这种药物是一种糖尿病药物这一观点有些执迷不悟：一项定性研究探讨了心脏病专家和肾病专家对钠-葡萄糖共转运蛋白 2 抑制剂起始治疗的看法。

'We are somehow fixated on this being a diabetes drug': a qualitative study exploring the views of cardiologists and nephrologists about sodium-glucose cotransporter 2 inhibitor initiation.

机构信息

Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia.

Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia.

出版信息

Intern Med J. 2024 Apr;54(4):559-567. doi: 10.1111/imj.16203. Epub 2023 Aug 7.

DOI:10.1111/imj.16203

PMID:37548317

Abstract

BACKGROUND

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are now indicated for heart failure and chronic kidney disease (CKD), irrespective of the presence of diabetes. Hence, cardiologists and nephrologists have an important role in initiating these drugs.

AIMS

To explore cardiologists' and nephrologists' perspectives regarding initiating SGLT2i and their safety monitoring practices when initiating SGLT2i.

METHODS

Purposive and snowball approaches were used to recruit participants working in diverse areas in New South Wales, Australia. Semi-structured interviews were conducted with 12 cardiologists and 12 nephrologists. Interviews were conducted until thematic saturation was reached. Emergent themes were identified from transcripts. An iterative general inductive approach was used for data analysis.

RESULTS

There was a reluctance amongst most non-heart-failure subspecialist cardiologists to initiate SGLT2i. Reasons included the perception of SGLT2i as diabetes drugs, concern about side effects, lack of experience and issues with follow-up. In contrast, nephrologists reported feeling confident to initiate SGLT2i. Nephrologists varied in their opinions about the severity of CKD at which SGLT2i initiation was reasonable and monitoring of renal function following initiation. Government subsidisation was an important factor in the decision to prescribe SGLT2i to people without diabetes.

CONCLUSIONS

Our findings highlight the complex transition from the perception of SGLT2i as diabetes drugs to cardiometabolic and reno-protective agents. Interdisciplinary collaboration may enable greater confidence amongst specialists to initiate SGLT2i, including in patients with CKD. Additionally, there is a need for clear and detailed guidance about SGLT2i prescription in patients with renal dysfunction and renal function monitoring following SGLT2i initiation.

摘要

背景

钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）如今被推荐用于心力衰竭和慢性肾脏病（CKD），无论是否存在糖尿病。因此，心脏病专家和肾病专家在启动这些药物方面发挥着重要作用。

目的

探讨心脏病专家和肾病专家在启动 SGLT2i 方面的看法以及他们在启动 SGLT2i 时进行安全性监测的做法。

方法

采用目的抽样和滚雪球抽样方法在澳大利亚新南威尔士州不同领域招募参与者。对 12 名心脏病专家和 12 名肾病专家进行了半结构化访谈。访谈在达到主题饱和时结束。从转录本中确定了出现的主题。采用迭代式一般归纳方法进行数据分析。

结果

大多数非心力衰竭亚专科心脏病专家不愿意启动 SGLT2i。原因包括将 SGLT2i 视为糖尿病药物的看法、对副作用的担忧、缺乏经验以及随访问题。相比之下，肾病专家报告说有信心启动 SGLT2i。肾病专家对启动 SGLT2i 的合理 CKD 严重程度以及启动后肾功能监测的意见不一。政府补贴是决定向无糖尿病患者开具 SGLT2i 的重要因素。