Most Diabetic Kidney Disease Patients Leave Hospital Without Proven Protective Drugs Like Semaglutide | Research

The takeaway

Only 7.4% of hospitalized type 2 diabetes patients with kidney disease were prescribed a GLP-1 agonist at discharge, despite strong evidence these drugs protect kidneys and hearts.

33.2% discharged on zero protective drugs
One-third of patients with T2D and CKD left hospital without any SGLT2 inhibitor, GLP-1 agonist, finerenone, or ACEi/ARB

What the researchers found

Among 2,216 patients with type 2 diabetes and chronic kidney disease discharged from an Australian hospital (2020–2024), only 21.3% were prescribed an SGLT2 inhibitor and 7.4% a GLP-1 agonist — despite strong evidence these drugs improve renal and cardiovascular outcomes. Only 3.6% received semaglutide specifically, and a mere 0.1% received finerenone. One-third (33.2%) of patients were discharged on none of the four recommended protective drug classes. Encouragingly, prescribing trends improved over the study period: SGLT2 inhibitor prescriptions rose from 7.9% to 38.7% (P<0.001) and GLP-1 agonist prescriptions from 6.3% to 11.7% (P=0.007).

Why it matters

Major clinical trials have established that SGLT2 inhibitors, GLP-1 agonists like semaglutide, and finerenone protect the kidneys and heart in patients with type 2 diabetes and CKD. Yet this real-world data reveals a massive gap between evidence and practice: most patients leave the hospital without these proven treatments. Identifying and addressing barriers to prescribing could significantly reduce kidney failure and cardiovascular events in this high-risk population.

The numbers in context

n=2,216 · Mean age 78.2 years · ACEi/ARB: 56.1% · SGLT2i: 21.3% · GLP-1 agonist: 7.4% · Semaglutide: 3.6% · Finerenone: 0.1% · None of 4 classes: 33.2% · SGLT2i trend: 7.9%→38.7% · GLP-1 trend: 6.3%→11.7%

How the study worked

Retrospective cohort study of the ReDiCare project. Identified patients with T2D and CKD admitted to a quaternary hospital in Western Australia between January 2020 and September 2024 using ICD-10-AM codes and eGFR data. CKD was defined as eGFR <60 mL/min/1.73m² for >3 months. Discharge medications were analyzed for prescribing of SGLT2 inhibitors, GLP-1 agonists, finerenone, and ACE inhibitors/ARBs. Time trends in prescribing were assessed across the study period.

Who was studied

2,216 patients with type 2 diabetes and chronic kidney disease discharged from a Western Australian quaternary hospital (2020–2024)

What this study cannot tell us

Single-center study at one Australian hospital, limiting generalizability. Retrospective design relying on discharge prescription data — actual medication adherence not assessed. The elderly population (mean age 78.2) may have more contraindications or provider caution with newer agents. Reasons for non-prescribing (contraindications, cost, patient preference) were not captured.

How to read the evidence

Large retrospective observational study with over 2,200 patients from a single center. Provides strong real-world prescribing data but cannot explain why drugs weren't prescribed or assess patient outcomes.

When this study was published

Published in 2025 in Heart, Lung and Circulation. Covers prescribing from 2020–2024, reflecting the most recent trends in cardiorenal-metabolic drug adoption.

The bigger picture

This study reflects a global problem in cardio-renal-metabolic medicine: the gap between clinical trial evidence and real-world prescribing. Large trials like SUSTAIN-6, FLOW, and SELECT have demonstrated that GLP-1 agonists reduce cardiovascular events and slow kidney decline in diabetic patients. Yet adoption remains slow, particularly for newer agents. The data here — from a well-resourced quaternary hospital in a wealthy country — suggest the gap may be even larger in less-resourced settings. Closing this evidence-practice gap is one of the biggest opportunities to reduce morbidity in type 2 diabetes.

Questions still open

What are the main barriers to prescribing GLP-1 agonists and SGLT2 inhibitors in elderly CKD patients — cost, contraindications, or physician awareness?
Would hospital-based clinical decision support tools increase prescribing of evidence-based protective drugs at discharge?
How do prescribing rates at Australian hospitals compare to US and European centers?

Common questions

Why aren't more patients being prescribed these proven drugs?

This study couldn't determine the reasons, but common barriers include: cost and insurance coverage, physician unfamiliarity with newer agents, concern about side effects in elderly patients, clinical inertia (continuing old prescriptions rather than updating), and lack of specialist involvement in hospital discharge planning.

Is the prescribing situation improving?

Yes, but slowly. Over the study period (2020–2024), SGLT2 inhibitor prescribing nearly quintupled (7.9% to 38.7%) and GLP-1 agonist prescribing nearly doubled (6.3% to 11.7%). However, these rates are still well below the proportion of patients who would benefit from these medications based on clinical trial evidence.

Read the original research

Real-World Prescribing of Renal and Cardiovascular Protective Drugs in Patients With Type 2 Diabetes and Chronic Kidney Disease: Analysis of Data From a Western Australian Quaternary Hospital.

Heart, lung & circulation, 34(10), 1089-1097

View on PubMed ↗Publisher’s paper ↗

Citation

Lan, Nick S R; McFadden, Ben; Johnson, Andrew; Shedden, Phillip; Fegan, P Gerry; Puttagunta, Harish; Ho, Sharon; Gillett, Richard; Swaminathan, Ramyasuda; Dwivedi, Girish. (2025). Real-World Prescribing of Renal and Cardiovascular Protective Drugs in Patients With Type 2 Diabetes and Chronic Kidney Disease: Analysis of Data From a Western Australian Quaternary Hospital.. Heart, lung & circulation, 34(10), 1089-1097. https://doi.org/10.1016/j.hlc.2025.07.007