Prescribing practices and barriers to use of sodium-glucose cotransporter 2 inhibitors and glucagon-like Peptide-1 receptor agonists in adult kidney transplant recipients: A survey of endocrinology and nephrology prescribers

Clinical practice variability exists regarding the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in kidney transplant recipients (KTRs). The objective of this study was to understand prescribing practices and barriers for the use of SGLT2i and GLP-1RA among endocrinology and nephrology prescribers caring for KTRs. A 19-item electronic survey assessing prescribing practices and barriers for the use of SGLT2i and GLP-1RA in adult KTRs was distributed to all members of the Planning Research in Inpatient Diabetes/Planning Research in Outpatient Diabetes (PRIDE/PROUD) group and the American Society of Transplantation Kidney Pancreas Community of Practice via email listservs between July and November 2023. Endocrinology and nephrology prescribers caring for adult KTRs with type 2 diabetes mellitus (T2DM) or post-transplant diabetes mellitus (PTDM) were eligible. A total of 50 responses were included for analysis (n = 25 endocrinology, n = 25 nephrology). Respondents prescribed SGLT2i and GLP-1RA to adult KTRs with T2DM/PTDM with the following frequency: always (4% SGLT2i, 6% GLP-1RA), often (34% SGLT2i, 30% GLP-1RA), sometimes (34% SGLT2i, 36% GLP-1RA), rarely (22% SGLT2i, 20% GLP-1RA), or never (6% SGLT2i, 8% GLP-1RA). The most common indication for both drug classes was diabetes mellitus (DM)/hyperglycemia (84% SGLT2i, 90% GLP-1RA). Most prescribers felt comfortable initiating a SGLT2i (58%) or GLP-1RA (62%) between 1 and 6 months post-transplant. Prescribers were always or often concerned about infection (67%) with the use of SGLT2i and gastrointestinal intolerance (66%) with GLP-1RA. Cost of treatment/insurance coverage/need for prior authorization and patient concern for drug cost was identified as being very likely or likely barriers for prescribing these drug classes post-transplant (54% SGLT2i, 62% GLP-1RA). SGLT2i and GLP-1RA are prescribed mainly for DM/hyperglycemia by endocrinology and nephrology prescribers between 1 and 6 months postkidney transplant. Concerns surrounding medication access and cost were the most frequently reported barriers to use.