SUN-855 - Real-World Prescribing Patterns of Sodium-glucose cotransporter‑2 inhibitors in Primary Care for Patients With Class 1A Indications

Background: Sodium–glucose cotransporter‑2 inhibitors (SGLT2i) have a Class 1A recommendation for patients with heart failure (HF) and chronic kidney disease (CKD) as they have been shown to significantly improve cardiorenal outcomes, regardless of the presence of type 2 diabetes (T2DM). However, prior studies demonstrate persistently low US prescription rates ( < 25%) despite strong guideline endorsement.


Objective: This retrospective study aimed to evaluate current prescription rates and prescribing patterns of SGLT2i among patients meeting Class 1A indications in primary care clinics at a tertiary-care urban academic medical center in a large US city.

Methods: SGLT2i carry a Class 1A recommendation for patients with 1) diabetes and atherosclerotic cardiovascular disease (ASCVD), HF, or CKD, 2) albuminuria with urine albumin creatinine ratio (UACR) ≥200 mg/g regardless of diabetes status, or 3) HF regardless of diabetes status. Patient encounters meeting these Class 1A criteria were identified from the electronic health record (EHR) between August 5, 2024 and August 5, 2025 using ICD-10 codes. Patient characteristics were compared between those prescribed SGLT2i and those not prescribed SGLT2i using Chi-square test for categorical variables and Student's t-test for continuous variables. Statistical significance was set at p < 0.05.

Results: The study cohort included 1951 patients who met Class 1A criteria for SGLT2i prescription, among whom 36% (n = 703) were prescribed SGLT2i. Patients were more likely to be prescribed SGLT2i if they met a Class 1A indication. Prescription rates varied by qualifying indication. The proportion of patients with T2DM and ASCVD who were prescribed SGLT2i was significantly higher (38.4%) than the number of patients with T2DM and ASCVD who were not prescribed SGLT2i (33.4%, p < 0.0001). Similar patterns were observed among patients with T2DM and CKD (38.0% vs 24.9%, p < 0.0001), T2DM and HF (24.5% vs 10.0%, p< 0.0001), and HF alone (12.7% vs 8.7%, p< 0.006). Overall, SGLT2i prescribing was also more common among patients with either a diagnosis of T2DM (81.9% vs 80.7%, p < 0.0001), HF (46.4 vs 30.9%, p< 0.0001), or CKD (45.5% vs 32.4%, p < 0.0001).

Conclusion and limitations: Patients meeting Class 1A indications, as well as those with diagnoses of T2DM, CKD, or HF, were more likely to be prescribed SGLT2i. Overall, SGLT2i prescription rates among guideline‑eligible patients in our cohort were higher than those reported in the literature. This study was limited by reliance on automated EHR data extraction, which may not have captured all eligible encounters during the study period and did not incorporate UACR, potentially resulting in an overestimation of rates. Ongoing analyses aim to incorporate these additional data to more accurately assess SGLT2i utilization among guideline‑eligible patients, followed by an intervention to enhance prescription rates.

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