Population health approach to optimize SGLT-2 prescribing in a Veteran cohort

Abstract:The prevalence of diabetes mellitus in the United States has continued to increase and now has a prevalence exceeding 20% in the population over 65 years old. It is to be expected that both macrovascular and microvascular complications related to diabetes mellitus will cause substantial morbidity and mortality unless the trends reverse or treatments are utilized to impact these outcomes. Sodium-glucose cotransporter-2 inhibitors (SGLT2) have shown significant benefits in reducing cardiovascular outcomes, including a reduction in admissions for congestive heart failure and death from cardiovascular events, as well as decreasing the progression of chronic kidney disease in individuals with and without diabetes. Despite the known benefits from this class of medications, the prescribing of SGLT2 inhibitors has lagged behind, likely from a combination of lack of knowledge and cost. In one epidemiologic study, only 11.9% of individuals with diabetes and a strong indication for an SGLT2 inhibitor received prescriptions for this medication. The Veterans Affairs (VA) healthcare system offers a unique opportunity to utilize a population health approach to influence prescribing patterns for SGLT2 inhibitors. A small study of 455 patients in a VA site showed a significant increase in prescriptions for SGLT2 inhibitors with patient identification and personal outreach to veterans identified as potentially benefiting from SGLT2 inhibitors. We aimed to create a team-based, population health approach to increase SGLT2 inhibitor prescriptions for all potentially eligible veterans diagnosed with type 2 diabetes mellitus and concomitant congestive heart failure, chronic kidney disease, or atherosclerotic heart disease (ASCVD). We report on the outcomes 3 months after implementation.