The gender gap in prescription pattern of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes

Abstract Background The major benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2DM) on cardiovascular outcome has been undoubtably proven in several landmark trials and different populations. In consideration of emerging evidence that there are clinically relevant gender-related differences in the course of T2DM and subsequent cardiovascular outcomes, it is unknown if SGLT2i therapy is gender independent utilized in clinical practice. In this regard, real-world data are needed to determine whether there is a gender gap in SGLT2i prescription and if this influences long-term outcome. Methods Patients with T2DM admitted to a tertiary academic center between 01/2014 and 04/2020 were identified through a search of electronic health records. Data on antidiabetic therapy was acquired at discharge, and were screened for SGLT2i prescription. Subsequently, the entire cohort was prospectively followed. Results In total, 812 patients (median age 70 years, 29.7% female) were included in the present analysis. Only 17.3% of the study population received an SGLT2i. In direct comparison between sexes, females show lower rates of SGLT2i prescription (11,2% vs. 19,8%, p=0.003), despite comparable patient characteristics. Furthermore, males show a significantly higher probability of SGLT2i prescription, illustrated as an adjusted odds ratio of 2.59 (CI 95% 1.29–5.19; p=0.008). During a median follow-up time of 2.3 years, a total of 142 patients died due to cardiovascular causes – corresponding to 103 (18.0%) male and 39 (16.2%) female participants. Females who did not receive a SGLT2i showed higher rates of chronic kidney disease (CKD, 25.2% vs. 7.4%, p=0.039) and greater levels of proBNP (2092 pg/ml (IQR: 738–5279) vs. 825 pg/ml (IQR: 298–2479), p=0.011) as compared to non-SGLT2i females. Conclusion Despite clear evidence on the beneficial effect of SGLT2i, the present data suggest a gender-gap in SGLT2i prescription and thus missed potential in female patients. The most common reason for not prescribing a SGLT2i in females was the presence of CKD. However, SGLT2i (i.e. Empagliflozin) are approved to use in individuals with a glomerular filtration rate (GFR) as low as ≥20ml/min, and therefore more awareness has to be raised, that SGLT2i are feasible to prescribe in such vulnerable patients with present cardiovascular comorbidities, to achieve a benefit as shown in several landmark trials. Additionally, more attention is needed to address this gender-gap and ensure that both sexes receive equal attention, in terms of state of the art T2DM therapy to reduce mortality and morbidity. Funding Acknowledgement Type of funding sources: None.