Evaluation of Sodium Glucose Cotransporter 2 Inhibitor Use in Patients with Type 2 Diabetes in a Primary Care Clinic

Abstract

Purpose: This study aims to evaluate the utilization of sodium glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes within a primary care clinic and explore pharmacist-led interventions for optimization of medication management. Findings may inform interventions to improve evidence-based prescribing and maximize the cardiovascular and renal benefits of SGLT2 inhibitors in this patient population.

Methods: A retrospective review of electronic medical records was conducted on patients with type 2 diabetes at a rural primary care clinic. The study included patients who were at least 18 years of age, had type 2 diabetes, and were current patients of the clinic as of March 2025. Data collected from the medical records included demographic data, past medical history, pharmacist involvement, hemoglobin A1c, weight, renal function, and diabetes medication prescribing history. The primary outcome of this study was to analyze the prescribing rates of SGLT2 inhibitors in patients with type 2 diabetes. Descriptive analysis methods were used to assess overall prescribing rates of SGLT2 inhibitors in this population, as well as subgroup analyses including patients managed by pharmacists, and patients with certain comorbidities such as clinical atherosclerotic cardiovascular disease (ASCVD) and heart failure.

Results: A total of 499 patients met inclusion criteria and were included in the analysis. Of these, 164 patients (32.9%) were managed by pharmacists. A total of 152 patients (30.5%) had an active prescription for an SGLT2 inhibitor. Within the pharmacist-managed patient population, a total of 88 patients had an SGLT2 inhibitor, representing 53.7% of pharmacist-management patients. For those without a pharmacist, a total of 64 patients had an SGLT2 inhibitor, representing 19.1% of patients without a pharmacist. Of the 499 patients with type 2 diabetes, 58 patients had clinical ASCVD, and 35 of these patients had pharmacist management. Within this group managed by a pharmacist, 25 patients (71.4%) were prescribed an SGLT2 inhibitor. When compared to patients with type 2 diabetes and clinical ASCVD without a pharmacist, 12 patients (52.1%) were prescribed an SGLT2 inhibitor. A total of 43 patients had type 2 diabetes and heart failure, with 17 of them being managed by a pharmacist. A total of 14 of these patients (82.4%) managed by a pharmacist received an SGLT2 inhibitor, compared to 18 (69.2%) of patients who did not have a pharmacist on their care team.

Conclusions: Patients being managed by a pharmacist were more likely to receive an SGLT2 inhibitor. Pharmacist-managed patients also had a higher rate of receiving SGLT2 inhibitors compared to patients without a pharmacist, for groups who had type 2 diabetes and either heart failure or clinical ASCVD. Results of this study support that the addition of a pharmacist in a primary care clinic can have a positive impact on prescribing rates of SGLT2 inhibitors, particularly in patients with clinical ASCVD or heart failure. Further studies will be conducted to expand pharmacy services to fill gaps of care and improve population-wide prescribing patterns.