Scottish Renal Association

Abstract

Intro: Sodium/glucose cotransporter-2 inhibitors (SGLT2i) reduce risk of progressive kidney disease both in and out with the setting of diabetes. The aims of this study were to quantify the current uptake of canagliflozin within patients with type 2 diabetes in nephrology units within the west of Scotland and to identify barriers to prescribing. Methods: A retrospective analysis of the Scottish Electronic Renal Patient Record (SERPR) was performed to patients to secondary care nephrology services within NHS Greater Glasgow and Clyde (GGC) and NHS Lanarkshire who were eligible for SGLT2i. Canagliflozin is licensed for treatment of diabetic kidney disease (DKD) in patients with type 2 diabetes, estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m, urinary albumin:creatinine ratio (uACR) >30 mg/mmol. A questionnaire was produced to identify attitudes towards prescribing SGLT2i’s. The survey was composed of 5 questions on GoogleForms and Survey Monkey platforms. These were disseminated via email to prescribers in NHS GGC (nephrology only) and NHS Lanarkshire (nephrology and medical specialties). Results: From the retrospective SERPR analysis, there were 74 patients in NHS Lanarkshire identified as eligible, of whom 8 (11%) had been prescribed canagliflozin. In NHS GGC, 148 patients were identified as eligible of whom 57 (38.5%) had been prescribed canagliflozin. There were 58 survey responses gathered in NHS Lanarkshire and 18 responses from NHS GGC. Within NHS Lanarkshire 35.5% of respondents were consultants, 19.0% were registrars, and 34.5% were foundation or core trainee doctors. Respondents in NHS Lanarkshire felt that the main responsibility for prescribing SGLT2i lay with diabetes (55.1%), then all specialties equally (39.7%), GP (20.7%) and cardiology (17.2%). Only 24.1% of respondents in NHS Lanarkshire had started a patient on an SGLT2i and 29.3% felt they had access to adequate information to commence a patient on SGLT2i. Within NHS GGC, 72.2% of respondents were consultants and 11.1% were registrars, 83.3% had prescribed SGTL2i and 94.4% of respondents felt as though they had adequate information to commence patients of SGLT2i treatment. Within NHS GGC 61.1% of respondents felt every specialty had equal responsibility to start patients on SGLT2i, followed by diabetes (33.3%), nephrology (33.3%) and GP (27.8%). Conclusion: SGLT2i prescribing in patients with DKD remains low. A variety of factors contribute towards this, including inadequate provision of information to clinicians regarding commencing SGLT2i, concerns over serious side effects of SGLT2i (such as euglycemic DKA) and disagreement over whose responsibility it should be to commence these medications. Providing furthereducation and readily accessible prescribing resources to clinicians, and particularly to training grade doctors, may help to increase uptake of SGLT2i.