Prevalence of SGLT2 inhibitor and GLP1 receptor agonist prescriptions in type 2 diabetes patients with and without chronic kidney disease: Analysis of an Australian primary care dataset.

Aims: 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.

Materials and methods: 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/1.73m² and urine albumin-creatinine ratio [UACR] ≥22.6 mg/mmol) and GLP1-RA (eGFR ≥50 to <75 mL/min/1.73m² and UACR >33.9 to <565 mg/mmol, or eGFR ≥25 to <50 mL/min/1.73m² and UACR >11.3 to <565 mg/mmol).

Results: 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.

Conclusion: 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.