Doctors often do not fully follow recommended care guidelines for heart and kidney problems in diabetes patients: A review of past cases in one Taiwan hospital
Only 28.4% of prescriptions adhered to cardiorenal-diabetic guidelines in patients with diabetes and comorbidities.
Patients receiving guideline-adherent prescriptions had higher average HbA1c levels and body mass index.
Older age is associated with a higher likelihood of physician nonadherence to guidelines.
A history of cerebrovascular accidents is linked to physician nonadherence.
Use of dipeptidyl peptidase 4 inhibitors is associated with nonadherence to recommended prescriptions.
Simplified
AIMS: In patients with diabetes and , sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are critical to secondary outcome prevention. This study investigated physicians' adherence to current cardiorenal-diabetic prescription guidelines for such patients.
MATERIALS AND METHODS: This observational, retrospective-cohort, single-center study enrolled 7,805 adults (mean age 71 years; mean HbA1c level 7.4%) with type 2 diabetes mellitus and atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or chronic kidney disease (CKD). Patients' demographic information, comorbidities, medication history, and laboratory data were collected. Physician adherence was defined as a patient with ASCVD receiving an SGLT2i or GLP-1 RA and a patient with CKD or HF receiving an SGLT2i. The baseline characteristics of the adherence and nonadherence groups were compared.
RESULTS: Only 28.4% of prescriptions adhered to guidelines. Patients in the physician-adherent group had higher HbA1c levels, body mass index, and age, and more comorbidities. Logistic regression revealed that older age [odds ratio (OR) 2.29, 95% confidence interval (CI) 2.014-2.604, P < 0.001], cerebrovascular accident history (OR 1.591, 95% CI 1.357-1.865, P < 0.001), and dipeptidyl peptidase 4 inhibitor use (OR 2.359, 95% CI 2.062-2.700, P < 0.001) were associated with physician nonadherence.
CONCLUSIONS: Only a suboptimal percentage of patients with diabetes and cardiorenal disease in Taiwan receive SGLT2is and GLP-1 RAs despite these medications' recognized cardiorenal benefits. Further action is required to improve physician adherence in patients with greater age, cerebrovascular accident history, and dipeptidyl peptidase 4 inhibitor use.
Key numbers
28.4%
Prescription Adherence Rate
Percentage of prescriptions adhering to guidelines for SGLT2is and GLP-1 RAs.
7,805
Patient Cohort Size
Total number of patients with type 2 diabetes included in the study.
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The authors declare no conflict of interest. Approval of the research protocol: The study protocol was approved by the Human Experiment and Ethics Committee of the National Cheng Kung University Medical Center (B‐ER‐113‐258). Informed consent: N/A. Registry and the registration no. of the study/trial: N/A. Animal studies: N/A.
