Pharmacist Outreach Doubles SGLT2 Inhibitor Uptake in CKD

Chronic kidney disease (CKD) affects approximately 15% of US adults and remains a leading cause of cardiovascular complications, kidney failure, and mortality. Although sodium-glucose cotransporter 2 (SGLT2) inhibitors have become a cornerstone of guideline-directed therapy for patients with type 2 diabetes (T2D) and CKD, many eligible patients still are not receiving these medications.¹

A new quality improvement study with findings published in JAMA Network Open evaluated whether proactive pharmacist outreach could increase SGLT2 inhibitor initiation among veterans with T2D with a hemoglobin A_1C (HbA_1C) of 7 or greater and CKD.¹

Researchers across 8 Veterans Affairs (VA) health systems identified more than 8600 eligible patients using the VA clinical diabetes dashboard. Patients assigned to the intervention group received an educational letter followed by a telephone consultation with a clinical pharmacist. When appropriate, pharmacists prescribed empagliflozin (Jardiance; Boehringer Ingelheim) and provided follow-up monitoring. Patients receiving usual care had no targeted outreach but could still receive an SGLT2 inhibitor through their primary care providers.¹

The intervention substantially improved medication uptake. Approximately one-third of patients (33.5%) in the pharmacist outreach group initiated an SGLT2 inhibitor compared with about 16% of patients receiving usual care. At 12 months, patients who received pharmacist outreach were about twice as likely to have filled an SGLT2 inhibitor prescription.¹

Several findings have important implications for pharmacists. The results demonstrate that pharmacists can successfully identify eligible patients using electronic health record dashboards and initiate guideline-directed therapy without increasing demands on primary care clinicians. Structured follow-up also created opportunities to reinforce adherence, manage adverse effects, review laboratory results, and provide ongoing patient education. Many patients who declined treatment reported wanting to discuss therapy with their primary care provider first, underscoring the importance of collaborative care and shared decision-making.¹

Although medication uptake improved substantially, the investigators did not observe significant differences in mortality, kidney failure, heart failure, myocardial infarction, or stroke during the 12-month follow-up period.¹ The investigators noted this was likely because only a minority of patients ultimately completed the full pharmacist intervention and because follow-up was limited to 1 year.

The findings suggest that pharmacist-led outreach represents a practical strategy for increasing use of evidence-based therapies in patients with CKD and type 2 diabetes. As evidence supporting the cardiorenal benefits of SGLT2 inhibitors continues to grow,² pharmacist-driven population health initiatives may help close the gap between guideline recommendations and real-world prescribing.

REFERENCES

1. Pestka DL, Murphy D, Kaplan AN, et al. Pharmacist outreach and SGLT2 inhibitor uptake in patients with diabetes and chronic kidney disease. JAMA Netw Open. 2026;9(5):e2613081. doi:10.1001/jamanetworkopen.2026.13081

2. Zhu Y, Lv C, Yang H, et al. Chronic cardiorenal syndrome: cardio-renal protective effect of SGLT2i. Ren Fail. 2025;47(1):2575921. doi:10.1080/0886022X.2025.2575921