Barriers to prescribing glucose-lowering therapies with cardiometabolic benefits

Background: The adoption of 2 classes of new diabetes medications, glucagon-like peptide 1 receptor agonists (GLP1RA) and sodium-glucose co-transporter-2 inhibitors (SGLT2i), has been slow in the United States despite their cardiovascular benefits in addition to their glucose-lowering effect. The objective of this study was to identify providers' perspectives about prescribing GLP1RA and SGLT2i. Methods: In this survey study, a questionnaire was administered between May 17, 2018, and June 11, 2018, in a large academic health care system. Ninety providers who practice in endocrinology, primary care, or cardiology responded the questionnaire, with a 36.3% response rate. The questionnaire explored knowledge, comfort level, beliefs, perceived barriers, and hypothetical clinical decisions about prescribing GLP1RA and SGLT2i. Results: Findings suggested a division of views from endocrinology and primary care providers versus cardiology providers. More than 88% of endocrinology providers and about 50% of primary care providers prescribed GLP1RA or SGLT2i at least 6 times a year, whereas less than 7% of cardiology providers prescribed either medication. All endocrinology providers, approximately 78% of primary care providers, and only 21% of cardiology providers were very comfortable or comfortable in all 4 knowledge aspects about GLP1RA and SGLT2i. Major barriers to prescribing GLP1RA and SGLT2i for endocrinology and primary care providers were cost and nonapproved prior authorizations, yet the top 3 reported barriers for cardiology providers were lack of knowledge about these medications, concerns of introducing confusion into diabetes care, and discomfort of prescribing diabetes medications. Conclusions: Barriers to prescribing GLP1RA or SGLT2i are unique for endocrinology, primary care, and cardiology providers. Given the cardiovascular benefits of these medications, this study suggests specific areas and potential opportunities for clinicians to improve care for patients with diabetes and cardiovascular disease.