Kurevija Tomislav, Šojat Dunja, Bilić-Ćurčić Ines, Canecki-Varžić Silvija, Trtica-Majnarić Ljiljana
Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia.
Health Center of Osijek-Baranja County, Osijek, Croatia.
BMC Prim Care. 2025 May 2;26(1):143. doi: 10.1186/s12875-025-02837-7.
The treatment approaches of type 2 diabetes (T2D) are being transformed, due to the availability of novel antidiabetic medications, sodium-glucose co-transporter 2 inhibitors (SGLT2ins), and glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Despite their proven beneficial effects, recent research points to their insufficient prescription. This study aimed to reveal the prescription rates of SGLT2ins and GLP-1 RAs among general practitioners (GPs) in Croatia and to examine factors associated with their low self-confidence in prescribing them.
A self-designed survey questionnaire was used and delivered to the GPs' e-mail addresses in digital format. The data on the number of individuals diagnosed with T2D and prescribed new antidiabetic medications were checked by the respondents in their electronic database. Factors associated with lower GPs` self-confidence in prescribing SGLT2ins and GLP-1 RAs were assessed by bivariate and multivariate logistic regression analyses.
The study included 168 GPs (66.1% women; 49.4% specialists in family medicine) and a cohort of 23,036 individuals with T2D. The prescription rates of SGLT2ins and GLP-1 RAs were 21.0% and 14.4%, respectively. Specialists stated a higher level of self-confidence in prescribing these medications, compared to other respondents. In the multivariate models, a factor that was shown to reduce the likelihood of low GPs self-confidence in prescribing SGLT2ins was "familiarity with the side effects of these medications" (OR = 0.03), while factors that increased this likelihood were: "being familiar with GLP-1 RAs side effects" (OR = 4.8), "an insufficient knowledge and experience of GPs in adjusting two target outcome measures to the same patient" (OR = 2.2), and "the GPs assumption that the new guidelines protocol which separates two target outcome measures is useful only in some cases but not in all" (OR = 5.4). Regarding GLP-1 RAs, only one factor - "familiarity of GPs with GLP-1 RAs side effects", was shown to reduce the probability of GPs` low self-confidence in prescribing this group of medications (OR = 0.27).
It is of the utmost importance to identify barriers the GPs face when prescribing these medications, as well as to suggest potential strategies to optimize their prescription.
由于新型抗糖尿病药物、钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）和胰高血糖素样肽-1受体激动剂（GLP-1 RA）的出现，2型糖尿病（T2D）的治疗方法正在发生转变。尽管它们已被证明具有有益效果，但最近的研究指出其处方率不足。本研究旨在揭示克罗地亚全科医生（GP）中SGLT2i和GLP-1 RA的处方率，并检查与他们在开具这些药物时自信心不足相关的因素。
使用自行设计的调查问卷，以数字格式发送到全科医生的电子邮件地址。受访者在其电子数据库中检查被诊断为T2D并开具新抗糖尿病药物的个体数量数据。通过二元和多元逻辑回归分析评估与全科医生开具SGLT2i和GLP-1 RA时自信心较低相关的因素。
该研究纳入了168名全科医生（66.1%为女性；49.4%为家庭医学专科医生）以及23036名T2D患者队列。SGLT2i和GLP-1 RA的处方率分别为21.0%和14.4%。与其他受访者相比，专科医生表示在开具这些药物时自信心更高。在多变量模型中，显示可降低全科医生开具SGLT2i时自信心不足可能性的一个因素是“熟悉这些药物的副作用”（OR = 0.03），而增加这种可能性的因素是：“熟悉GLP-1 RA的副作用”（OR = 4.8）、“全科医生在为同一患者调整两个目标结局指标方面知识和经验不足”（OR = 2.2）以及“全科医生认为将两个目标结局指标分开的新指南方案仅在某些情况下有用，并非在所有情况下都有用”（OR = 5.4）。关于GLP-1 RA，只有一个因素——“全科医生熟悉GLP-1 RA的副作用”，显示可降低全科医生开具这类药物时自信心不足的概率（OR = 0.27）。
识别全科医生在开具这些药物时面临的障碍，并提出优化其处方的潜在策略至关重要。
