Jack Gwendolyne A, Avenatti Eleonora, Kashyap Sangeeta R, Sadhu Archana R
Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine-New York Presbyterian, New York, NY 10065, USA.
Division of Cardiology, Weill Cornell and Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, TX 77030, USA.
J Clin Endocrinol Metab. 2025 Aug 7;110(9):e2852-e2863. doi: 10.1210/clinem/dgaf301.
Despite mounting evidence supporting the cardio-kidney benefits of sodium/glucose cotransporter 2 inhibitors (SGLT2i), significant disparities in their use exist among people with type 2 diabetes (T2D), cardiovascular, or kidney disease that reveals a significant disconnect between guidelines and practice. These discrepancies are particularly pronounced among women, minority races, and lower socioeconomic groups. These groups remain underrepresented in major cardiovascular trials, potentially leading to their exclusion from optimal therapies and increasing morbidity and mortality rates. This review aims to highlight disparities in the use of SGLT2i in populations with T2D, chronic kidney disease, heart failure, and atherosclerotic cardiovascular disease. It examines the factors that influence the prescription of SGLT2i within these populations and evaluates their downstream impact on clinical outcomes. Finally, the review summarizes recent clinical trial findings on strategies that enhance the adoption of SGLT2i and other cardioprotective agents through a multifaceted approach, aiming to improve real-world adoption for patients with T2D and/or cardiovascular and kidney diseases.
尽管越来越多的证据支持钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对心脏和肾脏有益，但2型糖尿病（T2D）患者、心血管疾病患者或肾脏疾病患者在使用这些药物方面存在显著差异，这表明指南与实践之间存在重大脱节。这些差异在女性、少数族裔和社会经济地位较低的群体中尤为明显。这些群体在主要心血管试验中的代表性仍然不足，这可能导致他们无法获得最佳治疗，从而增加发病率和死亡率。本综述旨在强调T2D、慢性肾脏病、心力衰竭和动脉粥样硬化性心血管疾病患者在使用SGLT2i方面的差异。它研究了影响这些人群中SGLT2i处方的因素，并评估了其对临床结局的下游影响。最后，本综述总结了最近的临床试验结果，这些结果涉及通过多方面方法提高SGLT2i和其他心脏保护药物采用率的策略，旨在改善T2D和/或心血管疾病及肾脏疾病患者在现实世界中的用药情况。
