Factors Associated With Initiation of Sodium–Glucose Cotransporter 2 Inhibitor and Glucagon-Like Peptide 1 Receptor Agonists in Patients With Diabetes and Kidney Disease: A Post Hoc Analysis of the Kidney CHAMP Trial

OBJECTIVE Negative social determinants of health (SDOH) are associated with greater kidney disease incidence and progression, partly because of suboptimal management. We studied the association of demographic, clinical, and individual- and contextual-level SDOH factors with sodium–glucose cotransporter 2 (SGLT2) inhibitor and glucagon-like peptide 1 (GLP-1) receptor agonist initiation in patients with type 2 diabetes and whether these associations were modified by the Kidney Coordinated HeAlth Management Partnership (K-CHAMP) population health management (PHM) program. RESEARCH DESIGN AND METHODS Using data from the K-CHAMP trial, which cluster-randomized 101 primary care offices to a control arm or the PHM intervention (including nephology electronic consultation, chronic kidney disease education, and pharmacist medication review), we explored associations between SGLT2 inhibitor and GLP-1 receptor agonist initiation with a priori patient factors using adjusted Poisson regression. Enrolled patients with type 2 diabetes who were not prescribed an SGLT2 inhibitor or a GLP-1 receptor agonist at baseline were included. Effect modification by K-CHAMP was assessed using interaction terms. RESULTS The cohort had 891 patients (402 receiving the PHM intervention and 489 in the control group). Of the participants, 55% were female and 89% were White; the cohort had a mean age of 73 ± 9 years, mean BMI of 33 ± 7 kg/m 2, mean A1C of 7.3 ± 1.5%, and mean estimated glomerular filtration rate of 37.4 ± 8.3 mL/min/1.73 m 2; and 24% were rural living. Over a median follow-up of 17.7 months (interquartile range [IQR] 12.4–23.8 months), 238 (26.7%) initiated an SGLT2 inhibitor or GLP-1 receptor agonist. In adjusted analysis, age (incidence rate ratio [IRR] 0.92, 95% CI 0.85–0.99) and A1C (IRR 1.15, 95% CI 1.07–1.24) were significantly associated with SGLT2 inhibitor or GLP-1 receptor agonist initiation. The K-CHAMP PHM intervention did not significantly modify association of any factors. CONCLUSION Younger age and higher A1C were associated with increased likelihood of initiating an SGLT2 inhibitor or GLP-1 receptor agonist. Other demographic, clinical, and SDOH factors were not significantly associated with medication initiation. The K-CHAMP PHM intervention did not moderate the association of patient-level or SDOH factors with initiation of an SGLT2 inhibitor or GLP-1 receptor agonist.