Pharmacist-Led Outreach Boosts SGLT2 Inhibitor Initiation in Veterans With CKD and Diabetes

Key Takeaways

• A pharmacist-led outreach program across 8 Midwestern US Department of Veterans Affairs (VA) health systems significantly increased initiation of sodium-glucose cotransporter 2 (SGLT2) inhibitors among eligible patients with chronic kidney disease (CKD) and type 2 diabetes.
• One year after assignment, 33.5% of patients in the intervention group filled an SGLT2 inhibitor prescription compared with 15.5% in the usual care group.
• Despite improved medication uptake, the intervention did not significantly affect a composite clinical outcome that included mortality, kidney failure, heart failure, myocardial infarction, and stroke.

A quality improvement study conducted across 8 VA health systems in the Midwestern US found that pharmacist-led outreach substantially increased initiation of SGLT2 inhibitors among veterans with type 2 diabetes and CKD. The findings highlight the potential role of clinical pharmacists in addressing persistent gaps in the adoption of guideline-recommended therapies for high-risk patients.

Pharmacist-Led Outreach Drives SGLT2 Inhibitor Use in Veterans With CKD

Researchers evaluated whether targeted pharmacist outreach could increase use of SGLT2 inhibitors in eligible veterans with CKD and type 2 diabetes. The study was conducted between February 2022 and April 2024 using an established VA diabetes dashboard to identify patients who met eligibility criteria.

A total of 8658 patients were included. The mean age was 78.7 years, and 96.7% were male. Patients were pseudorandomly assigned to either a pharmacist intervention group (4400 patients) or a usual care group (4258 patients) based on the last digit of their Social Security number.

Patients in the intervention arm received a mailed letter describing the benefits of SGLT2 inhibitors and were scheduled for a 30-minute telephone consultation with a pharmacist. Eligible patients identified during the consultation were prescribed empagliflozin. Patients receiving usual care did not receive targeted outreach.

The primary outcome was initiation of an SGLT2 inhibitor, defined by prescription fill during the study period. At 1 year, the cumulative proportion of filled SGLT2 inhibitor prescriptions was 33.5% in the intervention group vs 15.5% in the control group. Additionally, 19.6% of intervention patients filled an SGLT2 inhibitor prescription within 12 months compared with 9.7% of patients receiving usual care.

The intervention was associated with a significantly greater likelihood of treatment initiation, with a hazard ratio of 1.91 (95% CI, 1.69-2.16; P < .001).

Researchers also evaluated exploratory clinical outcomes using a win ratio analysis. No statistically significant difference was observed in the composite outcome of all-cause mortality, kidney failure, heart failure, myocardial infarction, and stroke (win ratio, 1.02; 95% CI, 0.97-1.07; P = .54).

Intervention Doubles Medication Initiation Compared With Usual Care

SGLT2 inhibitors have demonstrated substantial benefits for patients with type 2 diabetes and CKD, including improvements in kidney and cardiovascular outcomes. However, real-world prescribing remains below recommended levels despite strong evidence supporting their use.

The findings suggest that clinical pharmacists may serve as an effective resource for identifying eligible patients and facilitating initiation of high-value therapies. Pharmacists often have expertise in medication management and, in many practice settings, authority to initiate, modify, or discontinue treatment. These capabilities position them to address therapeutic gaps that may persist in routine care.

For health systems, payers, and managed care organizations, the study provides evidence that structured outreach programs can improve uptake of evidence-based medications. However, the absence of a measurable improvement in clinical outcomes during the study period suggests that broader implementation strategies and greater intervention reach may be necessary to translate increased prescribing into population-level health benefits.

The results also underscore the importance of developing scalable approaches to ensure eligible patients receive therapies known to reduce the risk of kidney and cardiovascular complications.

Findings Highlight Barriers to Broader SGLT2 Inhibitor Adoption

The investigators concluded that pharmacist-led outreach was associated with a significant increase in SGLT2 inhibitor initiation among veterans with CKD and type 2 diabetes. However, they noted that “limited intervention reach may have constrained the overall impact.” The authors emphasized that additional strategies are needed to improve medication uptake and maximize the benefits of broader SGLT2 inhibitor implementation efforts across eligible patient populations in the VA system and beyond.

Future Strategies Needed to Maximize Clinical Impact

In a large Midwestern US VA quality improvement study, pharmacist-led outreach nearly doubled SGLT2 inhibitor initiation among eligible veterans with CKD and type 2 diabetes. While clinical outcomes were unchanged during follow-up, the findings highlight the potential of pharmacist-driven care models to improve adoption of evidence-based therapies.

Reference

Pestka DL, Murphy D, Kaplan AN. 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