Diabetes is the10th leading cause of death globally, raising concerns associated with increased mortality and reduced life expectancy. It is also associated with several comorbidities such as cardiovascular, kidney, and liver diseases. Currently, most clinical practices recommend metformin as first-line therapy for individuals with type 2 diabetes (T2D). SGLT2 inhibitors are a new class of drugs being used in the treatment of T2D by lowing the kidney glucose reabsorption. Hence, the urinary glucose excretion is increased followed by a decrease in blood glucose level establishing a cardiovascular and renoprotective profile. However, uptake rates of the SGLT2 inhibitor are low in patients with T2D.

A review was conducted to evaluate possible barriers and multidisciplinary methods to overcome them. Patient factor such as socioeconomic status was considered to influence the uptake because of the drug cost. This was held for cases in the US where health insurance coverage is a major concern. From a clinician’s point of view, safety profile, lack of guidelines, lack of understanding regarding benefits, and lack of information regarding treatment regimen were identified as potential barriers. 

SGLT2 inhibitor administration rates vary among different clinical specialties such as endocrinology, primary care, cardiology, and nephrology with cardiology being the lowest prescriber of them all (1%-5%). Endocrinology was found to be the highest prescriber at 10%-15%. It was found that primary care practitioners experienced more challenges in following SGLT2-related guidelines as they had fewer opportunities to gain knowledge about its renoprotective and cardiovascular protective nature in T2D patients. Also, the uptake rate seemed to vary between countries with Canada and Israel showing a steep increase in the numbers while the numbers remained low in the UK and US. Hence, awareness and knowledge about the SGLT2 medication should be provided to both patients and clinicians to encourage the administration of the drug and improve long-term health benefits in T2D patients.

Khunti K ey al., Diabetes Obes Metab. 2022 Mar 3. doi: 10.1111/dom.14684.