Diabetes Metab J.  2022 Sep;46(5):701-712. 10.4093/dmj.2022.0002.

Real-World Prescription Patterns and Barriers Related to the Use of Sodium-Glucose Cotransporter 2 Inhibitors among Korean Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease

• Baek JH
• Yang YS
• Ko SH
• Han KD
• Kim JH
• Moon MK
• Park JS
• Lee BW
• Oh TJ
• Chon S
• Choi JH
• Hur KY
• Committee of Clinical Practice Guidelines
• Korean Diabetes Association

• KMID: 2533639
• DOI: http://doi.org/10.4093/dmj.2022.0002

Abstract

Background
To evaluate prescription trends and clinical factors of the sodium-glucose cotransporter 2 inhibitors (SGLT2i) use according to the presence of atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF) in Korean patients with type 2 diabetes mellitus (T2DM).
Methods
Prescription patterns of SGLT2i use between 2015 and 2019 were determined using the Korean National Health Insurance Service database of claims.
Results
Of all patients with T2DM (n=4,736,493), the annual prescription rate of SGLT2i increased every year in patients with ASCVD (from 2.2% to 10.7%) or HF (from 2.0% to 11.1%). After the first hospitalization for ASCVD (n=518,572), 13.7% (n=71,259) of patients initiated SGLT2i with a median of 10.6 months. After hospitalization for HF (n=372,853), 11.2% (n=41,717) of patients initiated SGLT2i after a median of 8.8 months. In multivariate regression for hospitalization, older age (per 10 years, odds ratio [OR], 0.57; 95% confidence interval [CI], 0.56 to 0.57), lower household income (OR, 0.93; 95% CI, 0.92 to 0.95), rural residents (OR, 0.95; 95% CI, 0.93 to 0.97), and dipeptidyl peptidase-4 inhibitor (DPP-4i) users (OR, 0.82; 95% CI, 0.81 to 0.84) were associated with lesser initiation of SGLT2i in ASCVD. Additionally, female gender (OR, 0.97; 95% CI, 0.95 to 0.99) was associated with lesser initiation of SGLT2i in HF.
Conclusion
The prescription rate of SGLT2i increased gradually up to 2019 but was suboptimal in patients with ASCVD or HF. After the first hospitalization for ASCVD or HF, older age, female gender, low household income, rural residents, and DPP-4i users were less likely to initiate SGLT2i.

Keyword

Asians; Cardiovascular diseases; Diabetes mellitus, type 2; Healthcare disparities; Heart failure; Sodium-glucose transporter 2 inhibitors

Figure

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  Fig. 1. Annual prescription rate of sodium-glucose cotransporter 2 inhibitor (SGLT2i) in patients with type 2 diabetes mellitus (T2DM) according to the presence of atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF). aThe presence of ASCVD or HF was determined whether the corresponding International Classification of Disease, 10th Revision (ICD-10) code presents in a given year regardless of hospitalization.

• 

  Fig. 2. Use of cardiovascular and antidiabetic medications among patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF) in 2019. Data were presented as percentage (%). ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blockade; DPP-4i, dipeptidyl peptidase-4 inhibitor; GLP-1RA, glucagon-like peptide-1 receptor agonist; SGLT2i, sodium-glucose cotransporter 2 inhibitor.

• 

  Fig. 3. Annual initiation rate of sodium-glucose cotransporter 2 inhibitor (SGLT2i) within a year after the first hospitalization for (A) atherosclerotic cardiovascular disease (ASCVD) or (B) heart failure (HF).

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  Fig. 4. Factors associated with sodium-glucose cotransporter 2 inhibitors (SGLT2i) initiation after the first hospitalization for (A) atherosclerotic cardiovascular disease (ASCVD) or (B) heart failure (HF) in patients with type 2 diabetes mellitus. DPP-4i, dipeptidyl peptidase-4 inhibitor; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blockade; ASA, aspirin; IHD, ischemic heart disease; CI, confidence interval. aP<0.001, bP<0.01.

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