Kidney Week

Abstract: FR-PO1031

Impact of Population Health Management to Modify Disparate Use of SGLT2 Inhibitors/Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs)

Session Information

• Social, Environmental, and Economic Determinants of Kidney Health
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Lavenburg, Linda-Marie Ustaris, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Linda-Marie Ustaris Lavenburg, DO, MS

• Han, Zhuoheng, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Zhuoheng Han

• Mosslemi, Mitra, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Mitra Mosslemi, MS

• Alghwiri, Alaa A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Alaa A. Alghwiri, PhD

• Nolin, Thomas D., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Thomas D. Nolin, PharmD, PhD, FASN

• Weltman, Melanie R., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Melanie R. Weltman, PharmD

• Yabes, Jonathan Guerrero, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Jonathan Guerrero Yabes, PhD

• Jhamb, Manisha, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Manisha Jhamb, MD, MPH

Background

Negative social determinants of health (SDOH) are associated with more CKD incidence and progression, partly due to suboptimal management. Sex and age differences in CKD management also exist. We studied whether population health management (PHM) modified the association of demographic differences and SDOH factors with initiation of SGLT2i or GLP1RA.

Methods

In this exploratory analysis of the Kidney Coordinated HeAlth Management Partnership (KCHAMP) trial which cluster randomized 101 primary care offices to control arm vs PHM intervention (nephology e-consult, CKD education, and pharmacist medication review). Enrolled patients with type 2 diabetes, not on baseline SGLT2i/GLP1RA were included. Associations between SGLT2i/GLP1RA initiation with a priori factors were examined in the control arm using Poisson regression with random practice intercept, adjusted for age, gender, race, BMI, Charlson Comorbidity Index, follow-up time as the offset. Effect modification by KCHAMP was assessed using interaction terms. Significance level 0.2 was used.

Results

Cohort had 891 patients (402 KCHAMP; 489 Control); 55% female; 11% black race/other; 89% white race; with mean±SD age 73±9yrs; BMI 33±7kg/m²; HbA1c 7.3±1.5%; and 18% were rural living. In the control arm, gender (IRR [95%CI] 1.07 [0.99-1.17]), and HbA1c (1.05 [1.02-1.10]) were significantly associated with SGLT2i/GLP1RA initiation. KCHAMP had a marginally significant interaction effect with BMI (1.06 [1.00-1.12]; p = 0.20).

Conclusion

We found disparities in SGLT2i/GLP1RA use due to age and gender. But, SDOH factors were not associated with drug use. The association between some factors (age, gender, BMI, HBA1c) with the initiation of drugs slightly differed between control and KCHAMP. We were under-powered to detect interaction effects of K-CHAMP, yet a marginally significant intervention interaction effect with BMI, suggests that KCHAMP may increase SGLT2i/GLP1RA use in those with higher BMI.

Funding

• NIDDK Support