Chronic Kidney Disease in Type 2 Diabetes: A Narrative Review of SGLT2 Inhibitor Uptake and the Gap Between Guideline and Prescription
DOI:
https://doi.org/10.5281/zenodo.22261282Keywords:
SGLT2 inhibitors, Chronic kidney disease, Guideline implementation, Prescribing disparities, Type 2 diabetesAbstract
Sodium-glucose cotransporter 2 inhibitors slow the progression of chronic kidney disease in type 2 diabetes, and guidelines
recommend them for that indication. Prescribing does not follow. In a cohort of 1,443,403 people with chronic kidney disease,
14.8 per cent were prescribed one, falling to 1.8 per cent among those with kidney disease alone. In England, among 587,826
people with type 2 diabetes, 19.9 per cent of those at high cardiovascular risk had a current prescription against 20.2 per cent of
those at low risk, so the indication made no difference to whether the drug was given. One finding reframes the problem: at a
tertiary centre, 83.4 per cent of patients documented as guideline-eligible received appropriate therapy, but only 1.6 per cent of
the diabetes population had eligibility recorded at all. Disparities are consistent across countries, with women, older patients,
Black patients and people in more deprived areas less likely to be treated. This review examines where the gap actually lies.
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