Identifying Provider Prescribing Practices for GLP‐1RAs and SGLT‐2is in Patients With Type 2 Diabetes to Address Pharmacoinequity

Background and Aims: Evidence-based treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with Type 2 diabetes (T2DM) focuses on glycemic control and lifestyle modification to achieve weight loss, which slows the progression of liver disease and reduces the risk of liver-related complications. We aimed to qualitatively explore provider-level determinants in glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium/glucose cotransporter 2 inhibitors (SGLT-2is) prescription. Methods: We identified a cohort of 189 outpatient adult primary care providers who cared for at least 50 annual T2DM patients in a tertiary academic health system in the United States in 2021. GLP-1RA and SGLT-2i prescribing rates were calculated with a median rate of 0.494 (IQR 0.393-0.594). Guided by the Consolidate Framework for Implementation Research, we conducted 1:1 interviews with high-prescribing and low-prescribing providers. All providers interviewed were either MDs or DOs. Results: Nine providers from the high-prescribing quartile (prescribing rate 59.5%-78.6%) and eight from the low-prescribing quartile (prescribing rate 4.8%-39.3%) were interviewed. High-prescribing providers reported more patient-facing hours and exposure to GLP-1RAs and SGLT-2is in residency. All providers cited task-sharing, patient-provider relationship longevity, and medication effectiveness as facilitators of GLP-1RA and SGLT-2i prescription. Barriers to prescribing included medication costs, prior authorization processes, and prescription inertia. Using the Expert Recommendations for Implementing Change, we mapped barriers and facilitators to implementation strategies. Conclusions: This interview series identified key barriers and facilitators of GLP-1RA and SGTL-2i prescription. Implementation strategies may help improve prescribing highly effective, newer treatments in patients with T2DM, including those with metabolic comorbidities.