Greater physician knowledge linked to more guideline-aligned SGLT2 prescribing

Clinical takeaway: Review whether patients with type 2 diabetes and heart failure or chronic kidney disease could benefit from an SGLT2 inhibitor, and use guideline updates to reassess existing treatment plans.

Diabetes treatment increasingly prioritizes cardiovascular and kidney protection alongside glucose control, but adoption of recommended therapies remains uneven. A new study found greater increases in guideline-concordant SGLT2 inhibitor use among patients whose endocrinologists subsequently earned higher medical knowledge assessment scores.

Researchers analyzed 2017–2022 Medicare claims for 177,284 adults with type 2 diabetes treated by 1,061 endocrinologists. They examined medication fills before and after the 2019 American Diabetes Association guideline update, comparing patients targeted by the recommendations with those not targeted.

Among patients with heart failure or chronic kidney disease, adjusted annual SGLT2 inhibitor fill rates rose from 8.9% in 2018 to 30.1% in 2022. The increase exceeded that among patients without those conditions by 11.4 percentage points.

This comparative increase was 3.9 percentage points larger among patients of endocrinologists in the highest versus lowest score quartile on the American Board of Internal Medicine’s Longitudinal Knowledge Assessment. No significant association between scores and changes in GLP-1 receptor agonist use was detected.

The findings suggest that stronger medical knowledge may signal greater uptake of evidence-based treatment. However, scores were measured in 2022–2023, after most prescribing observations. The study does not establish that assessment participation improved prescribing.

“Our findings about which physicians are most likely to prescribe these medications underscore the importance of continuous learning and staying current with emerging evidence to help ensure patients receive the best possible care,” said senior author Rozalina McCoy, MD, MS.

Source: Gray BM, et al. (2026 Oct 27) JAMA Netw Open. Prescribing SGLTis and GLP-1 RAs for Patients With Type 2 Diabetes, Guideline Updates, and Longitudinal Knowledge Assessment Scores