A study published in the Canadian Journal of Kidney Health and Disease points to some underlying reasons why some doctors are still hesitant to prescribe kidney patients a sodium-glucose transport 2 (SGLT2) inhibitor, despite evidence that this type of medication can offer numerous benefits. SGLT2 inhibitors have been proven to help prevent cardiovascular complications, slow kidney disease progression, control blood pressure, and promote weight loss in people living with kidney disease, including those with or without diabetes. 

After a new medication has been proven effective in clinical trials, it can be common for there to be a delay in doctors prescribing it as not all doctors learn about the medication right away or feel confident in its use. 

“But there's overwhelming evidence that people who would be eligible for SGLT2 inhibitors haven’t been prescribed them, and we didn’t know why that's been the case,” explains Dr. Tae Won Yi, a nephrologist with the University of British Columbia. For example, one study found that less than half of patients eligible to be prescribed SGLT2 inhibitors actually had a prescription filled. 

To learn more about what barriers might be causing this lack of SGLT2 inhibitor uptake, Yi interviewed 21 clinicians in British Columbia and analyzed their feedback for key themes. 

The results show a lot of variability among doctors in terms of their levels of comfort and familiarity with the evidence supporting SGLT2 inhibitors. Some doctors expressed concern about side effects. While there are potentially some serious side effects, their occurrence has been low. 

As well, some doctors said they were hesitant to prescribe an additional medication to their patients whose disease appears to be under control. However, SGLT2 inhibitors often prevent long-term complications associated with kidney disease that aren’t immediately obvious, so it may be beneficial to prescribe the medication with the long-term benefits in mind.

Using the barriers identified in this study, Yi says BC Renal is in the midst of building on its  existing strategies to increase knowledge and comfort around prescribing SGLT2 inhibitors. For example, Yi presented a webinar last year on the medication’s uptake as part of the BC Renal Kidney Care Clinic education series, and has worked with colleagues to produce new handouts and resources for patients and providers, which will be shared broadly once finalized. 

Importantly, the study shows that these tactics can contribute to doctors gaining the knowledge they need to feel confident about prescribing the medication. “We found that clinicians were very happy to be engaged and learn more about the evidence base,” says Yi. 

Of note, financial barriers to prescribing SGLT2 inhibitors were a key issue identified in this study, but following BC Renal advocacy and other contributing factors, they are now covered by the Ministry of Health’s Pharmacare program, paving the way for easier access for those who would benefit from them.