Wallace Hannah, Wick James, Neuen Brendon L, Buizen Luke, Badve Sunil V, Chalmers John, de Oliveira Costa Juliana, Falster Michael O, Ha Jeffrey T, Jardine Meg J, Ketema Daniel Bekele, Lin Jialing, Nelson Craig, Pearson Sallie-Anne, Peiris David, Rodgers Anthony, Sasaki Takaya, Woodward Mark, Gallagher Martin, Kotwal Sradha S, Ronksley Paul, Jun Min
The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.
Western Health, Melbourne, Victoria, Australia.
Diabetes Obes Metab. 2025 Jul 16. doi: 10.1111/dom.16608.
Sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have cardio-kidney-metabolic benefit. This study aimed to understand the prevalence of prescription of SGLT2 inhibitors and GLP1-RA among patients with T2DM with and without chronic kidney disease (CKD) in Australian primary care.
We conducted a retrospective, cohort study of adults with T2DM who attended primary care practices participating in MedicineInsight. The outcome of interest was the percentage of patients with CKD who received ≥1 prescription for an SGLT2 inhibitor or a GLP1-RA (assessed separately) compared to those without CKD during 2020-2021. We also assessed prescriptions in a sub-population of CKD patients who met trial inclusion criteria: SGLT2 inhibitor (estimated glomerular filtration rate [eGFR] ≥20 mL/min/1.73m and urine albumin-creatinine ratio [UACR] ≥22.6 mg/mmol) and GLP1-RA (eGFR ≥50 to <75 mL/min/1.73m and UACR >33.9 to <565 mg/mmol, or eGFR ≥25 to <50 mL/min/1.73m and UACR >11.3 to <565 mg/mmol).
Of 114 499 adults with T2DM, 36 840 (32.1%) also had CKD. SGLT2 inhibitors were prescribed in 13.6% of patients without CKD, 14.4% of patients with CKD and 17.8% of patients meeting the trial target population definition. Across these groups, GLP1-RA were prescribed in 8.8%, 10.1% and 11.3% of patients, respectively. More advanced CKD stage and severely increased albuminuria were associated with a lower likelihood of SGLT2 inhibitor or GLP1-RA being prescribed.
We observed low rates of SGLT2 inhibitor and GLP1-RA prescriptions in patients with T2DM irrespective of CKD status. Strategies are needed to improve prescription rates, with a particular focus on patients with high kidney and cardiovascular risk.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2抑制剂）和胰高血糖素样肽-1受体激动剂（GLP1-RA）具有心脏-肾脏-代谢益处。本研究旨在了解澳大利亚初级医疗中2型糖尿病（T2DM）伴或不伴慢性肾脏病（CKD）患者中SGLT2抑制剂和GLP1-RA的处方率。
我们对参与医学洞察项目的初级医疗机构中患有T2DM的成年人进行了一项回顾性队列研究。感兴趣的结果是2020 - 2021年期间，患有CKD的患者中接受至少1次SGLT2抑制剂或GLP1-RA处方（分别评估）的患者百分比与未患CKD的患者相比。我们还评估了符合试验纳入标准的CKD患者亚组中的处方情况：SGLT2抑制剂（估算肾小球滤过率[eGFR]≥20 mL/min/1.73m²且尿白蛋白-肌酐比值[UACR]≥22.6 mg/mmol）和GLP1-RA（eGFR≥50至<75 mL/min/1.73m²且UACR>33.9至<565 mg/mmol，或eGFR≥25至<50 mL/min/1.73m²且UACR>11.3至<565 mg/mmol）。
在114499例患有T2DM的成年人中，36840例（32.1%）也患有CKD。未患CKD的患者中13.6%开具了SGLT2抑制剂处方，患CKD的患者中为14.4%，符合试验目标人群定义的患者中为17.8%。在这些组中，GLP1-RA的处方率分别为8.8%、10.1%和11.3%。CKD分期越晚和蛋白尿严重增加与开具SGLT2抑制剂或GLP1-RA处方的可能性越低相关。
我们观察到无论CKD状态如何，T2DM患者中SGLT2抑制剂和GLP1-RA的处方率都很低。需要采取策略提高处方率，尤其要关注肾脏和心血管风险高的患者。
