Shen Zong-Yu, Ou Horng-Yih
Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Diabetes Investig. 2025 Aug;16(8):1535-1542. doi: 10.1111/jdi.70090. Epub 2025 May 30.
In patients with diabetes and cardiorenal comorbidities, sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are critical to secondary outcome prevention. This study investigated physicians' adherence to current cardiorenal-diabetic prescription guidelines for such patients.
This observational, retrospective-cohort, single-center study enrolled 7,805 adults (mean age 71 years; mean HbA1c level 7.4%) with type 2 diabetes mellitus and atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or chronic kidney disease (CKD). Patients' demographic information, comorbidities, medication history, and laboratory data were collected. Physician adherence was defined as a patient with ASCVD receiving an SGLT2i or GLP-1 RA and a patient with CKD or HF receiving an SGLT2i. The baseline characteristics of the adherence and nonadherence groups were compared.
Only 28.4% of prescriptions adhered to guidelines. Patients in the physician-adherent group had higher HbA1c levels, body mass index, and age, and more comorbidities. Logistic regression revealed that older age [odds ratio (OR) 2.29, 95% confidence interval (CI) 2.014-2.604, P < 0.001], cerebrovascular accident history (OR 1.591, 95% CI 1.357-1.865, P < 0.001), and dipeptidyl peptidase 4 inhibitor use (OR 2.359, 95% CI 2.062-2.700, P < 0.001) were associated with physician nonadherence.
Only a suboptimal percentage of patients with diabetes and cardiorenal disease in Taiwan receive SGLT2is and GLP-1 RAs despite these medications' recognized cardiorenal benefits. Further action is required to improve physician adherence in patients with greater age, cerebrovascular accident history, and dipeptidyl peptidase 4 inhibitor use.
在患有糖尿病和心肾合并症的患者中，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）对预防次要结局至关重要。本研究调查了医生对这类患者当前心肾糖尿病处方指南的遵循情况。
这项观察性、回顾性队列、单中心研究纳入了7805名患有2型糖尿病和动脉粥样硬化性心血管疾病（ASCVD）、心力衰竭（HF）或慢性肾脏病（CKD）的成年人（平均年龄71岁；平均糖化血红蛋白水平7.4%）。收集了患者的人口统计学信息、合并症、用药史和实验室数据。医生的遵循情况定义为患有ASCVD的患者接受SGLT2i或GLP-1 RA，患有CKD或HF的患者接受SGLT2i。比较了遵循组和不遵循组的基线特征。
只有28.4%的处方符合指南。医生遵循组的患者糖化血红蛋白水平、体重指数和年龄更高，合并症更多。逻辑回归显示，年龄较大[比值比（OR）2.29，95%置信区间（CI）2.014 - 2.604，P < 0.001]、有脑血管意外病史（OR 1.591，95% CI 1.357 - 1.865，P < 0.001）以及使用二肽基肽酶4抑制剂（OR 2.359，95% CI 2.062 - 2.700，P < 0.001）与医生不遵循有关。
尽管SGLT2i和GLP-1 RA具有公认的心肾益处，但台湾地区只有未达最佳比例的糖尿病合并心肾疾病患者接受了这些药物治疗。需要采取进一步行动来提高年龄较大、有脑血管意外病史以及使用二肽基肽酶4抑制剂的患者中医生的遵循率。
