Disparities in SGLT2i Prescription for Primary Prevention of ASCVD in Patients with T2D

Introduction and Objective: Identify disparities in SGLT2i prescription (SGLT2i-Rx) for primary prevention of Atherosclerotic Cardiovascular Disease (ASCVD) in adults with T2D. Methods: Retrospective analysis of a large hospital system Electronic Health Record (EHR) database. Results: From June 2016-August 2023, 791,873 ambulatory encounters were included. Dialysis and pregnancy were excluded. EHR phenotyping [≥2 appropriate ICD10 codes on subsequent visits AND diabetes defining labs or T2D medications] identified 38,435 with T2D and without ASCVD (age 61.5±9 yrs, 52% women, 48% Non Hispanic White (NHW), 37% private insurance (PI), 32% Medicare and 71% within less deprived ADI Quintiles (1-3). Cardiometabolic comorbidities included obesity 57%, HTN 78%, dyslipidemia (DL) 54%, CKD 13%, heart failure (HF) 3%, and smoking 7%. SGLT2i-Rx was very low (n=6275, 16.3%) and more common in younger age (61 ± 12 vs 62 ± 13 yrs), men (57%), NHW (49%), less deprived ADI (70%), PI (41%), obesity (57%), higher A1C (7.7% vs 7.0%), HF (4.0 vs 2.8%,) DL (62 vs 51%), HTN (82 vs 77%) and CKD (17 vs 12%) vs. no SGLT2i-Rx. Logistic regression analysis showed men were significantly more likely to have SGLT2i-Rx after adjustment for age, race/ethnicity, socioeconomics, and comorbidities. Conclusion: In a large primary prevention cohort of T2D with high cardiometabolic burden, SGLT2i-Rx was low overall, and disproportionately lower in women, indicating possible provider and patient gender biases. Disclosure: A.R. Sadhu: Advisory Panel; Abbott Diagnostics. E. Avenatti: None. R. Gullapelli: None. K. Nasir: Research Support; Novartis Pharmaceuticals Corporation, ESPERION Therapeutics, Inc. Advisory Panel; Amgen Inc, Merck Sharp & Dohme Corp, ER Squib & Sons. Research Support; National Institutes of Health, PCORI. S.R. Kashyap: Research Support; Fractyl Health, Inc. Advisory Panel; GI Dynamics. Research Support; Janssen Pharmaceuticals, Inc, Novartis Pharmaceuticals Corporation.