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The following is a summary of “Optimizing SGLT2 inhibitor and GLP-1 RA prescribing in high-risk patients with diabetes: a Department of Veterans Affairs quality improvement intervention,” published in the March 2025 issue of BMC Primary Care by Yun et al. 

Many patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), and/or heart failure (HF) do not receive sodium glucose cotransporter-2 (SGLT2) inhibitors and Glucagon-like peptide-1 receptor agonists (GLP-1 RA) despite their benefits. A quality improvement (QI) intervention aimed to increase their use. 

Researchers conducted a retrospective study to assess the impact of a QI intervention on SGLT2 inhibitor and GLP-1 RA use. 

They implemented education, 1:1 pharmacist-clinician coaching, and audit-feedback at Veterans Affairs Ann Arbor Healthcare System (VAAAHS). Outreach and in-reach targeted patients with T2D and ASCVD, CKD, or HF who are not on GLP-1 RAs or SGLT2 inhibitors. VA national reports identified patients and assessed outcomes. A difference-in-difference analysis compared prescribing rates at VAAAHS to Veterans Integrated Service Network (VISN) and VA nationally before, during, and after the intervention. 

The results showed that home telehealth nurses and clinical pharmacy practitioners (CPPs) reached 445 patients, with 48% (n=215) initiating SGLT2 inhibitors or GLP-1 RAs. Then 4 CPPs conducted 101 academic detailing sessions for 72 providers. Prescribing rates increased from 22.7% to 37.9% in VAAAHS, 20.3% to 28.4% in VISN 10, and 18.7% to 26.5% nationally over 12 months. About 6 months post-intervention, rates rose to 42.4% in VAAAHS, 32.2% in VISN 10, and 30.2% nationally. Growth in VAAAHS was significantly faster (P<0.001). 

Investigators increased the number of SGLT2 inhibitors and GLP-1 RA prescriptions by about 8%, faster than the national average. 

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-025-02709-0