Trends and Appropriateness of Sodium-glucose Co-transporter 2 Inhibitors Use in Qatar

Abstract

Background: Sodium glucose co-transporter 2 inhibitors (SGLT2is) are the most recently approved class of oral antidiabetic drugs (ADDs). The objective of this study was to explore the trends in the use of SGLT2is compared to other oral ADDs, to evaluate the appropriateness of prescribing SGLT2is, and to determine the factors associated with SGLT2is prescribing in Qatar. Methods: This is a two-phase study. Phase 1 was a descriptive, retrospective crosssectional study, where relevant data on all oral ADDs prescriptions from 2016 to 2020 in Hamad Medical Corporation (HMC) were collected. Phase 2 was an analytical, retrospective cross-sectional study, and it included patients newly initiated on SGLT2is and/or other oral ADDs during 2020. Prescriptions of patients newly initiated on SGLT2is (dapagliflozin and empagliflozin) were evaluated for appropriateness based on indication, dosage, and contraindication according to American and the Canadian labelling standards. Multivariable logistic regression analysis was conducted to investigate factors associated with prescribing SGLT2is. Results: SGLT2i prescriptions increased over the years after their introduction to HMC’s formulary in 2017. Consistently, sulfonylurea prescriptions declined between 2017 and 2020. Empagliflozin prescribing showed an increase over dapagliflozin, which decreased by the end of 2018. SGLT2is were prescribed for appropriate indication in 400 (100%) patients studied, while inappropriate dosing was found in 13 (3%) patients. Male gender (odds ratio [OR], 1.692; 95% confidence interval [CI], 1.015 to 2.822; P=0.044), patients with a baseline glycated hemoglobin (HbA1c) >7% (OR, 3.219; 95% CI, 1.838 to 5.637; P<0.001) and atherosclerotic cardiovascular disease (ASCVD) (OR, 2.182; 95% CI, 1.053 to 4.523), patients on metformin (OR, 7.556; 95% CI, 4.460 to 12.802; P<0.001), sulfonylureas (OR, 2.301; 95% CI, 1.160 to 4.563; P=0.017), and dipeptidyl peptidase 4 inhibitors (DPP4is) (OR, 3.430; 95% CI, 2.004 to 5.871; P<0.001) were more likely to be prescribed a SGLT2i. Conversely, patients with chronic kidney disease (CKD) were less likely to be prescribed a SGLT2i (OR, 0.359; 95% CI, 0.148 to 0.872; P=0.024). Conclusion: SGLT2is have largely replaced sulfonylureas in clinical practice in Qatar, with a greater utilization for empagliflozin over dapagliflozin. SGLT2is were very likely to be prescribed for an appropriate indication. Gender, baseline HbA1c level, history of ASCVD, history of CKD, and the use of metformin, sulfonylureas, or DPP4is were associated with initiating SGLT2is. Exploring the prescribing pattern of oral ADDs and how their trend was affected by the addition of SGLT2is, as well as evaluating the appropriate usage of this class based on indication, dosing, and contraindication is necessary. Further detailed investigation of the factors associated with prescribing SGLT2is at the patient-, provider-, and hospital- level may help to get a more comprehensive evaluation of the possible predictors for prescribing these novel agents.