Abstract 14777: Poor Utilization of Sodium Glucose Cotransporter-2 Inhibitors in Diabetic Patients With Coronary Artery Disease

Abstract

Introduction: Sodium glucose cotransporter-2 inhibitors (SGLT2is) are antihyperglycemic agents found to significantly reduce cardiovascular mortality and heart failure hospitalizations for type 2 diabetics with cardiovascular disease. Despite guidelines from international and national societies recommending the initiation of SGLT2is in this patient population, there are many at-risk patients who have not received this life-saving therapy. We examined this at-risk population at Scripps Health and aimed to address potential barriers to the prescribing of SGLT2is. Methods: SlicerDicer, a data analysis tool in Epic the electronic health record, was utilized to assess population data. With the support of the hospital pharmacy and therapeutics committee, SGLT2is, Empagliflozin and Dapagliflozin, were put on formulary and available for inpatient initiation in April 2022. Results: From January to December 2021 across all Scripps Health campuses, there were 1050 type 2 diabetics with hemoglobin A1c > 5.7%, the majority of whom were treated with antihyperglycemic agents, with GFR > 30 mL/min/1.73m 2 , who underwent PCI for coronary artery disease. Of those patients, more than 75% were not on an SGLT2i. After SGLT2is were available for initiation in the inpatient setting, informational and educational sessions were provided to health care providers, including physicians, nurses, and other allied health professionals. These sessions reviewed current guidelines, how to prescribe the medication, and the side effects to monitor. New workflow was created such that inpatient prescription of SGLT2is would trigger pharmacy support with the submission of prior authorizations and patient counseling. Conclusions: Despite strong guideline recommendations for the use of SGLT2is from cardiology and diabetes societies, a minority of diabetic patients with coronary artery disease, free of contraindications, receive this therapy. This represents an important opportunity to improve patient outcomes. We used a multi-pronged approach to address foreseeable barriers to the prescription of SGLT2is in this at-risk population.