Discrepancies in Prescribing Practices for SGLT2 Inhibitors Between Sexes

Background/Synopsis

In recent years, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant benefits in both cardiovascular and renal outcomes, which has resulted in increased provider utilization and inclusion into society guidelines. As the use of SGLT2i expands, variations in prescribing practices may arise.

Objective/Purpose

To identify variations in prescribing practices in SGLT2i among patients of different sex with either congestive heart failure (CHF) or chronic kidney disease (CKD).

Methods

A cross-sectional analysis of all patients prescribed SGLT2i between 2018 and 2023 within the Northwell Health system in New York State was conducted. Demographic data, including race, sex, ICD-10 codes for CHF and CKD, and last documented GFR, were retrieved from the electronic medical record. Patients were considered to have CKD with an appropriate indication for SGLT2i if they had an ICD-10 code for CKD or a GFR between 30 and 60. This data was then compared to the prevalence of CHF and CKD in men and women as reported in the Medicare Current Beneficiaries Survey (MCBS) of Fall 2021.

Results

From 2018 to 2023, of the 11,290 patients were prescribed SGLT2i, 12.7% had CHF and 10.5% had CKD. Of the patients with CHF, 27.6% were women, and of the patients with CKD, 33.9% were women. Within MCBS, women comprised 48.9% of patients with CHF and 51.9% of patients with CKD.

Conclusions

While according to MCBS, CHF and CKD affect men and women in approximately equal proportions, our data suggests that less women were prescribed SGLT2i. This discrepancy may represent different prevalence of CHF and CKD in men and women in New York State, contraindications to SGLT2i that are more likely to be present in women, or a systematic bias. Alternatively, prescribers may be hesitant to prescribe SGLT2i to women, given the FDA warning regarding increased risk of genitourinary infections. Ultimately, this study reveals a potential underlying bias in prescribing practices for SGLT2i between men and women that would benefit from further study and enhanced clinician awareness.