Study Reveals Significant Care Gap in SGLT2 Inhibitor Use for Diabetes and HF, Despite Real-World Benefits

Canada: A recent population-level cohort study conducted in Alberta, Canada, sheds light on the real-world impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in adults with diabetes and heart failure (HF). The study that reviewed patient data across the province found that only 10% of individuals with both conditions were prescribed SGLT2 inhibitors, despite the clear benefits these medications offer.

The study, published in the Canadian Journal of Diabetes, highlights a significant care gap due to the underuse of SGLT2 inhibitors despite their association with real-world reductions in heart failure hospitalizations and all-cause mortality.

"The study underscores the opportunity to enhance management and the need for tools and strategies to optimize the use of SGLT2 inhibitors in individuals with diabetes and heart failure," the researchers wrote.

SGLT2 inhibitors are a class of diabetes medications that prevent glucose reabsorption in the kidneys, thus lowering blood sugar levels. Emerging research has also highlighted their cardiovascular benefits, particularly for patients with heart failure.

Since 2016, clinical guidelines have endorsed SGLT2 inhibitors for individuals with type 2 diabetes and heart failure. Sonia Butalia, University of Calgary, Calgary, Alberta, Canada, and colleagues examined SGLT2i dispensation, factors associated with dispensation, HF hospitalization, and all-cause mortality in people with diabetes and HF.

For this purpose, a retrospective, population-based cohort study was conducted to identify individuals with diabetes and heart failure in Alberta, Canada, from 2014 to 2017. These patients were tracked for at least three years to monitor SGLT2 inhibitor dispensation and outcomes. Multivariate logistic regression was employed to evaluate factors influencing SGLT2i dispensation, while propensity scores and regression adjustments were used to estimate the impact of SGLT2i treatment on heart failure hospitalizations.

The study revealed the following findings:

• Among 22,025 individuals with diabetes and heart failure (43.4% women, mean age 74.7±11.8 years), only 10.2% were dispensed an SGLT2i.
• Male sex, age <65 years, a higher baseline glycated hemoglobin, no chronic kidney disease, presence of atherosclerotic cardiovascular disease, and urban residence were associated with SGLT2i dispensation.
• Lower heart failure hospitalization rates were observed in those with SGLT2i dispensation (548.1 per 100 person-years) versus those without (813.5 per 1,000 person-years) and lower all-cause mortality in those with an SGLT2i than in those without (48.5 per 1,000 person-years versus 206.1 per 1,000 person-years).
• Regression adjustment found that SGLT2i therapy was associated with a 23% reduction in hospitalization.

'Our study reveals a significant care gap in the underuse of SGLT2 inhibitors, with only 1 in 10 individuals with diabetes and established heart failure receiving these medications. Despite this, SGLT2 inhibitors were linked to notable real-world reductions in heart failure hospitalizations and all-cause mortality," the researchers concluded.

"This underscores a major opportunity to enhance cardiovascular management for people with diabetes, highlighting the urgent need for tools and strategies to optimize the use of SGLT2 inhibitors in this population."

Reference:

Butalia, S., Wen, C., Sigal, R., Senior, P., Quan, H., Chu, L. M., Yeung, R. O., & Kaul, P. (2024). Real-world Use and Outcomes of Sodium-Glucose Cotransporter-2 Inhibitors in Adults With Diabetes and Heart Failure: A Population-level Cohort Study in Alberta, Canada. Canadian Journal of Diabetes, 48(5), 305-311.e1. https://doi.org/10.1016/j.jcjd.2024.03.004