Sodium-Glucose Cotransporter-2 inhibitor (SGLT2i) Prescription Rates Amongst Diabetologists for Type 2 Diabetes Patients with Albuminuric Diabetic Kidney Disease: A Real-World Study at a Diabetes Center in Bangkok.

Background: Despite the beneficial effects of SGLT2i in reducing kidney disease progression and mortality in people with diabetic kidney disease (DKD), the use of SGLT2i in this population remains low. Objective: To explore the prescription rates of SGLT2i in type 2 diabetes (T2D) patients with albuminuric DKD and to assess clinician-perceived barriers to prescribing SGLT2i. Methodology: A retrospective study of all medical records of T2D patients with albuminuric DKD and eGFR ≥20 ml/min/1.73m2 in 2023 who had been treated by 13 diabetologists was conducted at Vimut-Theptarin Hospital, a private tertiary diabetes center in Bangkok. In cases of no documentation of non-prescribed SGLT2i, treating physicians were contacted to explore the reasons. Result: A total of 282 medical records were reviewed (mean age 65.9 ± 10.0 years, A1C 7.5 ± 1.2 %, duration of diabetes 19.7 ± 10.4 years, mean eGFR 68.3 ± 24.1 mL/min/1.73 m2, median UACR 151 (IQR 309) mg/g Cr, RAS inhibitors usage 80.1%). The SGLT2i prescription rate was 58.9% in 2023. Coronary artery disease, age ≥65 years, eGFR <60 mL/min/1.73 m2, optimal A1C and LDL control, use of thiazolidinedione were associated with SGLT2i prescription. Clinical inertia (31.9 %) was the most common reason for not prescribing SGLT2i in eligible patients, followed by cost concerns (18.1%) and frailty of patients (15.5%). Conclusion: Prescribing SGLT2i to T2D patients with albuminuric DKD remains suboptimal among diabetologists due to clinical inertia, medication costs, and frailty. Our study underscores actions aimed at improving SGLT2i prescription rates in routine practice.