Education Improves SGLT2 Inhibitor and GLP1-RA Prescribing, Benefits Cardiology Patients

A study published in the American Journal of Preventive Cardiology found a systematic educational approach overcomes obstacles in prescribing guideline-directed antihyperglycemic medications.

Managing type 2 diabetes (T2D) has shifted beyond glycemic control to a more comprehensive strategy including lowering cardiovascular and kidney risks. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like-peptide-1 receptor agonists (GLP1-RA) are standard of care, but prescribers underutilize them despite their benefits.

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SGLT2i reduce major adverse cardiovascular events (MACE) and mortality in patients with T2D and atherosclerotic cardiovascular disease. They also improve outcomes in patients with heart failure. Among patients with T2D, GLP1-RA reduce MACE, all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke. Recently, GLP1-RA have become popular because they support weight loss in eligible patients with obesity.

Cost and difficulty with insurance authorizations limit prescribers from using SGLT2i and GLP1-RA in practice. Specialty providers, particularly those in cardiology, are uncomfortable writing prescriptions for glucose-lowering medications, according to the study authors.

A multidisciplinary group of physicians and pharmacists created an initiative to address challenges in SGLT2i/GLP1-RA uptake and utilization across the largest health care system in New York State. They termed the initiative “Beyond Diabetes.” It promotes using these antihyperglycemic medications by offering educational sessions, practice support tools (e.g., secure pharmacy chat), patient-specific point-of-care dashboards (“Snapshot”) within the electronic health record (EHR), and patient education materials in 4 languages (English, Spanish, Hindi, and Chinese).

Researchers compared prescribing rates between the 6 months pre- and post- Beyond Diabetes’ implementation. They found significant increases in prescriptions for both medications by 24.4% (SGLT2i 37.4% and GLP1-RA 14.6%) across all specialties and in first-time prescribers. Continuing medical education attendees reported the education would encourage them to make changes in their practice (69.3%). Knowledge survey results found that staff answered 14.7% more questions correctly after education.

Because this initiative coincided with the COVID-19 pandemic, the authors acknowledge possibly skewed results. The Beyond Diabetes initiative will continue expanding available resources to improve prescribing these medications at discharge. Educating on new guidance-directed therapies may potentially improve patients’ clinical outcomes.

About the Author

Ashley Walsh, PharmD, is a pharmacist at Mohegan Pharmacy in Uncasville, CT.

Reference

Hirsh BJ, Hirsch JS, Hmoud H, et al. A system approach to improving guideline-directed therapy for cardio-renal-metabolic conditions: The "beyond diabetes" initiative. Am J Prev Cardiol. 2023;16:100608. doi:10.1016/j.ajpc.2023.100608