PSUN172 Prescribing SGLT-2 Inhibitors and GLP-1 Agonists in Primary Care: Improving Rates of Guideline-Concordant Practice
Authors: Schuetz Samantha , Carson Elizabeth , Gilbert Matthew , Gogerly-Moragoda Ruveni , Sobel Halle 
Published: November 2022

Abstract

Background
In practice, prescribing of a GLP-1 agonist (GLP-1a) or SGLT-2 inhibitor (SGLT-2i) for patients with type 2 diabetes mellitus (T2DM) and multiple risk factors for atherosclerotic cardiovascular disease (ASCVD) may be lagging behind the guidelines that recommend it. We aim to increase the prescribing rates of GLP-1as and SGLT-2is in a primary care resident clinic.

Methods
Eligible patients included adults with T2DM in an internal medicine primary care resident practice at the University of Vermont who were not already taking a SGLT-2i or GLP-1a. These patients were offered a diabetes medication management (DMM) visit with their PCP. The residents participated in a 30-minute educational intervention on: prescribing guidelines, medication risks and side effects, counseling patients, dose titration, and current Medicaid and Medicare insurance coverage estimates. This information was summarized in two tables that were included in a templated progress note to be used for DMM visits. DMM visits took place over a six month period. Chart review was conducted to determine patient co-morbidities and outcomes of the initial and follow-up DMM visits. Additional data was gathered from a post-visit survey completed by resident PCPs. Data was analyzed using descriptive methods.

Results
One hundred sixteen patients with T2DM were eligible. Sixty-five patients either declined, could not be reached, or did not present for their scheduled appointment. Fifty-one patients (44% of those eligible) completed a DMM visit. Of these 51, 18 (35%) were started on a SGLT-2i, either at the initial visit or at a follow-up visit. A GLP-1a was started for 14 (27%) patients. Nearly all who completed a DMM visit had at least one risk factor for ASCVD, and most had multiple risk factors. Problem lists for these patients showed that 40 (78%) had hypertension, 33 (65%) had hyperlipidemia, 12 (24%) had coronary artery disease, and 5 (10%) were current smokers. Two (4%) had a diagnosis of CHF, and 12 (24%) had CKD. Forty (out of 46) (87%) survey respondents reported that they were "more likely" to prescribe SGLT-2is and GLP-1as after participating in the intervention. The two most common reasons that these medications were not prescribed were the presence of competing visit priorities and co-management of diabetes medications by an endocrinologist.

Conclusions
Most patients with T2DM also have risk factors for ASCVD and would benefit from a GLP-1a or SGLT-2i. Prescriber education is an effective way to expand prescribing of these medications. Primary care providers are well-positioned to consider patients’ cardiovascular co-morbidities when prescribing diabetes medications, but may also be burdened by other visit priorities taking precedence. This study highlights the importance of a team-based approach to diabetes management and demonstrates a role for enhanced communication between primary care and specialties such as endocrinology and cardiology.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.