# Utilization Trends of SGLT2 Inhibitors in Croatian Clinical Practice: Observational Analysis

## TL;DR

This study examines how SGLT2 inhibitors are being used in Croatia for diabetes and related conditions over a ten-year period.

## Contribution

The paper provides new insights into the adoption trends of SGLT2 inhibitors in Croatia, emphasizing prescribing patterns and underutilization.

## Key findings

- SGLT2 inhibitor use in Croatia increased from 0.49 to 11.63 DDD/1000/day between 2014 and 2024.
- Dapagliflozin was the most prescribed SGLT2 inhibitor, likely due to its versatility and cost-effectiveness.
- SGLT2 inhibitors accounted for only 12% of non-insulin diabetes prescriptions in 2024, indicating underutilization.

## Abstract

Background and Objectives: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have emerged as key agents in the management of type 2 diabetes mellitus (T2DM), with expanding indications in heart failure and chronic kidney disease. This study assessed national trends in SGLT2 inhibitor utilization in Croatia between 2014 and 2024 using data from IQVIA. Materials and Methods: Drug use was quantified in defined daily doses per 1000 inhabitants per day (DDD/1000/day), alongside financial expenditure and prescribing patterns. Results: Since their market introduction in 2014, SGLT2 inhibitor utilization increased from 0.49 to 11.63 DDD/1000/day by 2024. Fixed-dose combinations with metformin accounted for a growing share of prescribing, reflecting a shift toward adherence-friendly regimens. Dapagliflozin was the most prescribed agent, likely due to broad therapeutic versatility and favorable pricing. Despite these trends, SGLT2 inhibitors (monotherapy) seem to be underutilized, accounting for just 12% of non-insulin antidiabetic prescriptions in 2024. Conclusions: These findings highlight the gradual integration of SGLT2 inhibitors into national clinical practice and emphasize the need for targeted educational and policy efforts to overcome therapeutic inertia and align prescribing with evidence-based cardio-renal-metabolic care.