Background:Evidence from large randomized clinical trials supports the benefit of SGLT2i (sodium-glucose cotransporter-2 inhibitors) to improve cardiovascular and kidney outcomes in patients with type 2 diabetes with or at high risk for atherosclerotic cardiovascular disease or chronic kidney disease. Considering this evidence, which has been expanding since the product label indication for empagliflozin to reduce risk of cardiovascular death in 2016, clinician-level variation in the prescription of SGLT2i among US Medicare beneficiaries was evaluated.Methods:Antihyperglycemic medication prescribers were identified as those physicians and advanced practice providers prescribing metformin in Medicare part D prescriber data. In this cross-sectional study, the proportion prescribing SGLT2i was assessed overall and across specialties in 2018, with changes assessed from 2014 to 2018. SGLT2i use was compared with other second-line antihyperglycemic medication classes, sulfonylureas and DPP4is (dipeptidyl peptidase-4 inhibitors).Results:Among 232 523 unique clinicians who prescribed metformin for Medicare beneficiaries in 2018 (diabetes-treating clinicians), 45 255 (19.5%) prescribed SGLT2i. There was substantial variation across specialties—from 72% of endocrinologists to 14% of cardiologists who prescribed metformin also prescribed SGLT2i. Between 2014 and 2018, the number prescribing SGLT2i increased 5-fold from 9048 in 2014 to 45 255 in 2018. Among clinicians who prescribed both sulfonylureas and SGLT2i in 2018, SGLT2i was prescribed to a median 33 beneficiaries for every 100 prescribed sulfonylureas (interquartile range, 18–67). SGLT2i use relative to sulfonylureas increased from 19 (interquartile range, 11–34) per 100 in 2014 to 33 (interquartile range, 18–67) per 100 in 2018 (P_trend<0.001).Conclusions:Eighty percent of clinicians prescribing metformin to Medicare beneficiaries did not prescribe SGLT2i in 2018. Moreover, sulfonylureas prescriptions were 3 times more frequent than those of SGLT2is, although a pattern of increasing uptake may portend future trends. These findings highlight a baseline opportunity to improve care and outcomes for patients with type 2 diabetes.

中文翻译：

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美国医疗保险受益人钠-葡萄糖协同转运蛋白 2 抑制剂的处方模式

背景：来自大型随机临床试验的证据支持 SGLT2i（钠-葡萄糖协同转运蛋白 2 抑制剂）改善患有动脉粥样硬化性心血管疾病或慢性肾脏病或处于高风险的 2 型糖尿病患者的心血管和肾脏结局的益处。考虑到自 2016 年恩格列净降低心血管死亡风险的产品标签适应症以来这一证据一直在扩大，美国医疗保险受益人中 SGLT2i 处方的临床医生水平差异被评估。方法：抗高血糖药物处方者被确定为那些医生和先进的实践提供者在 Medicare D 部分处方数据中开出二甲双胍处方。在这项横断面研究中，2018 年对开具 SGLT2i 处方的比例进行了总体评估和跨专业评估，评估了 2014 年至 2018 年的变化。将 SGLT2i 的使用与其他二线抗高血糖药物类别、磺脲类药物和 DPP4is（二肽基肽酶 4 抑制剂）进行了比较。结果：在 2018 年为 Medicare 受益人开出二甲双胍处方的 232 523 名独特临床医生中（糖尿病-治疗临床医生），45 255 (19.5%) 人开了 SGLT2i。不同专业之间存在很大差异——从 72% 的内分泌学家到 14% 的心脏病学家，在开出二甲双胍处方的同时也开出了 SGLT2i。2014 年至 2018 年期间，开具 SGLT2i 处方的人数增加了 5 倍，从 2014 年的 9048 人增加到 2018 年的 45255 人。在 2018 年同时开具磺脲类药物和 SGLT2i 处方的临床医生中，每 100 例处方磺脲类药物中有 33 名受益人开具 SGLT2i 处方（四分位数范围） , 18–67).P_趋势<0.001）。结论：2018 年，有 80% 的临床医生向 Medicare 受益人开出二甲双胍处方，但没有开出 SGLT2i。此外，磺脲类药物的处方频率是 SGLT2is 的 3 倍，尽管摄取量增加的模式可能预示着未来的趋势。这些发现突出了改善 2 型糖尿病患者护理和结果的基线机会。