SGLT2 inhibitor use in type 2 diabetes in England: a population-based cross-sectional study of uptake of NICE guidance

ABSTRACT Aims An update to the NICE Type 2 diabetes (T2DM) guideline in February 2022 recommended an SGLT2 inhibitor be offered to people with cardiovascular disease (CVD) or heart failure (HF) as comorbidities and considered for people at high CVD risk. We report uptake of this guideline in England 18 months after its publication. Materials and Methods Observational cohort study using Clinical Practice Research Data Link records linked to hospital admissions. Presence of a current prescription for an SGLT2 inhibitor was evaluated in people with T2DM on 1 st September 2023, stratified by CVD category (CVD only; HF only; both; high CVD risk; low CVD risk) and chronic kidney disease status, and by age, gender, ethnicity, deprivation, and T2DM duration. Adjusted associations between patient characteristics and uptake were evaluated using logistic regression. Results In the cohort of 587,826 people with T2DM, the percentage with a current prescription was 19.5% for people with CVD, 29.4% for people with HF, 30.5% for people with both CVD and HF, and 19.9% and 20.2% respectively for people at high and low CVD risk. In age-stratified analyses uptake was higher in people with more comorbidities. In adjusted models, uptake was lower in people aged >60, women, Black people, and people living in areas of higher deprivation. Conclusions Whilst prescribing of SGLT2 inhibitors continues to rise in England, recent trends indicate an opportunity remains to increase uptake. Action is necessary to address inequalities by ethnicity and deprivation, and lower uptake for people with T2DM and CVD without HF.