The SGLT2i Treatment Gap in UK Primary Care: A Cross-Sectional RWE Study of Prescribing in Clinical Practice.

AIMS: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes in type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD) and chronic heart failure (CHF). Despite clinical guideline recommendations, SGLT2i uptake in UK primary care remains suboptimal and information on utilisation is limited. This study aims to quantify and describe the UK primary care population with T2DM, CKD and/or CHF who are eligible for but not currently prescribed an SGLT2i. MATERIALS AND METHODS: A cross-sectional study was conducted using routinely collected electronic health records from the Optimum Patient Care Research Database. Adults aged ≥ 18 years on 1 July 2024 were included. Descriptive analyses estimated disease prevalence (defined by morbidity-coded diagnosis), SGLT2i eligibility (defined using NICE clinical guidelines) and current SGLT2i treatment (defined as any SGLT2i prescription in the previous 2 months) by conditions and selected characteristics. Main results are based on diagnosed disease; in a separate CKD sensitivity analysis, indicative CKD (without a morbidity code) was defined using kidney function test results. RESULTS: In the study population of 9.8 million adults, prevalence was 6.52% for T2DM, 4.95% for diagnosed CKD (6.07% including indicative CKD) and 1.40% for CHF. Among all SGLT2i-eligible individuals, 17.5% were currently prescribed an SGLT2i. Current SGLT2i treatment was lowest in CKD-only patients (3.8% treated among eligible) and highest in those meeting eligibility criteria for all three indications (32.9% treated). SGLT2i treatment was lower in women and older adults. CONCLUSIONS: SGLT2i therapy is significantly underutilised in UK primary care, particularly for CKD. Equitable implementation of SGLT2i clinical guidelines is vital to improve cardio-renal-metabolic care.