Real-life underuse of SGLT2 inhibitors for patients with type 2 diabetes at high cardiorenal risk

Atherosclerotic cardiovascular disease (ASCVD), heart failure (HF) and chronic kidney disease (CKD) are major complications of type 2 diabetes (T2DM). The objectives of preventing these complications are not fully reached in clinical practice. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have proven their efficacy in reducing major cardiovascular events, diminishing hospitalization for HF and limiting the progression of CKD to end-stage kidney disease in placebo-controlled randomised trials in high-risk patients with T2DM. These evidence-based benefits were confirmed in real-life cohort studies worldwide compared with other glucose-lowering agents. However, real-world data showed that only a minority of eligible patients with T2DM received an SGLT2i, yet encouraging increase was observed in recent years. Surprisingly, in several studies less patients with comorbidities (especially CKD) were treated with SGLT2is compared with T2DM patients without these complications. Bridging the gap between evidence-based cardiorenal protection with SGLT2is and their underuse in daily clinical practice in patients with T2DM at high risk is crucial from a public health viewpoint. Multifaceted and coordinated interventions involving all actors should be implemented to incite the adoption of SGLT2is as part of routine cardiovascular and renal care among patients with T2DM at high risk for these comorbidities.