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

TL;DR

This study explores why some doctors prescribe newer diabetes drugs more than others, identifying factors like training and cost that affect treatment access.

Contribution

The paper identifies provider-level factors influencing the prescription of GLP-1RAs and SGLT-2is for T2DM patients, offering strategies to reduce pharmacoinequity.

Findings

High-prescribing providers had more patient-facing hours and residency exposure to GLP-1RAs and SGLT-2is.

Barriers to prescribing included medication costs and prior authorization processes.

Implementation strategies were mapped to address barriers and improve access to effective treatments.

Abstract

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.

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.

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.

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.