Knowledge, attitudes, and practices of Saudi physicians toward the use of SGLT-2 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes mellitus: a nationwide cross-sectional study.

BACKGROUND: Despite guidelines recommending sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) for type 2 diabetes mellitus (T2DM) patients with cardiovascular risk, utilization remains low. This study evaluated the knowledge, attitudes, and practices (KAP) of physicians in Saudi Arabia toward these agents. METHODS: A nationwide cross-sectional study was conducted among 399 physicians in Saudi Arabia between December 2024 and November 2025. Participants completed an online survey assessing pharmacological knowledge, their attitude, and prescribing practices. Multivariable logistic regression was used to identify independent determinants of KAP outcomes. RESULTS: Theoretical knowledge was high, with 91.0% of physicians demonstrating adequate knowledge of SGLT-2i and 78.4% for GLP-1RA. Conversely, only 23.6% held an overall positive attitude, while 75.4% met the threshold for appropriate practice. Notably, 90.0% of physicians identified medication availability and patient accessibility as constant prescribing barriers. Multivariable analysis showed that while knowledge scores were generally high, they did not independently guarantee a positive attitude. Older age was significantly associated with higher odds of inappropriate practice, whereas specialist status and higher attitude scores were linked to better clinical practices. CONCLUSION: The study highlights a significant dissociation between high theoretical knowledge and attitudinal hesitancy among Saudi physicians. These findings suggest that under-prescribing may be associated more with attitudinal and structural factors, such as limited medication access, than with knowledge deficits. Future interventions should prioritize building clinical confidence through academic detailing and addressing systemic access issues to optimize evidence-based management for patients with T2DM.