The gender gap in prescription pattern of Sodium-Glucose Cotransporter 2 inhibitors in patients with Type 2 Diabetes and Coronary Artery Disease

Abstract

Abstract Background Type 2 diabetes mellitus (T2DM) is a major risk factor for the development of coronary artery disease (CAD), which is the leading cause of morbidity and mortality in T2DM patients. In this regard, sodium-glucose 2 cotransporter (SGLT2) inhibitors have been proven to not only reduce the glycemic burden but additionally lower the risk of major adverse cardiovascular events in T2DM patients with established CAD or at high risk for CAD. However, previous studies have not dealt with SGLT2 inhibitor prescription under real-world conditions, especially if SGLT2 inhibitor therapy is sex-independently utilized in such patients. Methods Patients with T2DM and CAD admitted to a tertiary academic center between 01/2014 and 04/2020 were identified by searching electronic health records. Patient characteristics and data on antidiabetic therapy at discharge were assessed. Results The present analysis included 1498 patients, with a median age of 70 years and 36.3% of them being female. Overall, only 17.2% of the entire cohort received an SGLT2 inhibitor, with an increasing prescription trend during the observation period. Interestingly, the prescription rate of SGLT2 inhibitors showed significant differences between males and females with a significantly lower intention for prescription in women (18.7% vs. 13.3%, p=0.008), despite having comparable patient characteristics. Women who did not receive an SGLT2 inhibitor tended to present more frequently with chronic kidney disease, however only 43 women presented with an estimated glomerular filtration rate of <30ml/min/1.73m2, which does not explain the observed general gender gap. Furthermore, in a regression analysis male participants were found to have a significantly higher probability of SGLT2i prescription, illustrated as an adjusted odds ratio of 1.44 (CI 95% 1.022-2.022; p =0.037) compared to women. Conclusion SGLT2i are potentially underutilized in female patients with CAD and T2DM, despite an overall increasing prescription trend during the observation period. Reasons for withholding therapy could not be objectified. The present data indicate a major need to increase awareness of guideline-directed therapy, especially in female T2DM patients with established CAD.