Abstract: FR-PO329
Transitioning Adults with CKD and Type 2 Diabetes from a Dipeptidyl-Peptidase 4 Inhibitor to a SGLT2 Inhibitor: A Population Health Initiative
Session Information
- Diabetic Kidney Disease: Clinical Modeling, Diagnosis, Education, and More
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Toth-Manikowski, Stephanie M., Healthmap Solutions, Tampa, Florida, United States
- Forte, Abigail, Healthmap Solutions, Tampa, Florida, United States
- Kwawu, Richmond, Healthmap Solutions, Tampa, Florida, United States
- Urdaneta, Morgan E., Healthmap Solutions, Tampa, Florida, United States
- Shaps, Howard, Healthmap Solutions, Tampa, Florida, United States
Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2Is) are first-line therapy in adults with chronic kidney disease (CKD) and type 2 diabetes (T2DM). Compared to dipeptidyl peptidase-4 inhibitors (DPP-4Is), SGLT2Is superiorly slow CKD progression and may be cost neutral, depending on the payor or pharmacy benefit manager. This initiative evaluated the effect of using a population-level approach and provider outreach to improve SGLT2I prescribing patterns among diabetic adults with CKD already taking a DDP-4I.
Methods
Healthmap Solutions, a kidney population health company, used payor claims to identify adults with a “SGLT2I opportunity,” defined as having Stage 3 or 4 CKD, T2DM, and a prescription fill for a DPP-4I but not a SGLT2I. Healthmap communicated this information to primary providers of these individuals. Outreach was deemed successful if individuals with a SGLT2I opportunity were reviewed with the provider or staff via 1) an in-person visit or 2) email/fax communication, per provider request. During a 3-month follow-up period, pharmacy claims were reviewed to identify the proportion of individuals with a new SGLT2I prescription fill. A proportional t-test was used to determine significant change.
Results
Of an initial pool of 53,255 adults, we identified 364 eligible for the initiative (Figure). Successful outreach occurred with providers of 273 (75%) individuals of which 12 (4%) started a SGLTI in the follow-up period. Mean time to initiation was 10 days after outreach. Among individuals whose providers were not successfully reached (n=91; 25%), SGLT2I was initiated in 1 (1%) individual (z-score 1.47; p=0.07). Member characteristics by outreach were similar (Table).
Conclusion
A population-level approach can be used to identify individuals with T2DM and CKD who may benefit from SGLT2I initiation. More studies are needed to understand how best to engage providers in optimizing pharmaceutical management of CKD in this population.