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Risk–Treatment Paradox With SGLT2i, GLP1-RA Use in Patients at Risk of CKD

Many patients with type 2 diabetes (T2D) who are at increased risk of chronic kidney disease (CKD) do not receive renoprotective therapy with SGLT2 inhibitors (SGLT2i) and GLP1 receptor agonists (GLP1-RA), researchers report. In fact, the authors wrote that they “observed a ‘risk-treatment paradox,’ whereby patients with higher risk of adverse outcomes were less likely to receive these therapies.”

Cross-sectional analysis of VHA prescribing patterns in 2019 and 2020 showed the following: “Of 1,197,880 adults with T2DM, SGLT2i and GLP1-RA were prescribed to 11% and 8% of patients overall, and to 12% and 10% of those with concomitant CKD, respectively. In adjusted models, patients with severe albuminuria were less likely to be prescribed SGLT2i or GLP1-RA versus nonalbuminuric patients with CKD, with odds ratios (ORs) of 0.91 (95% CI 0.89, 0.93) and 0.97 (0.94, 1.00), respectively. Patients with a 10-year [atherosclerotic cardiovascular disease] risk >20% (vs. <5%), had lower odds of SGLT2i use (OR 0.66 [0.61, 0.71]) and GLP1-RA prescription (OR 0.55 [0.52, 0.59]). A 5-year ESKD risk >5%, compared with <1%, was associated with lower likelihood of SGLT2i prescription (OR 0.63 [0.59, 0.67]) but higher likelihood of GLP1-RA prescription (OR 1.53 [1.46, 1.61]).”

Source: Diabetes Care