Abstract
Despite mounting evidence supporting the cardio-kidney benefits of sodium/glucose cotransporter 2 inhibitors (SGLT2i), significant disparities in their use exist among people with type 2 diabetes (T2D), cardiovascular, or kidney disease that reveals a significant disconnect between guidelines and practice. These discrepancies are particularly pronounced among women, minority races, and lower socioeconomic groups. These groups remain underrepresented in major cardiovascular trials, potentially leading to their exclusion from optimal therapies and increasing morbidity and mortality rates. This review aims to highlight disparities in the use of SGLT2i in populations with T2D, chronic kidney disease, heart failure, and atherosclerotic cardiovascular disease. It examines the factors that influence the prescription of SGLT2i within these populations and evaluates their downstream impact on clinical outcomes. Finally, the review summarizes recent clinical trial findings on strategies that enhance the adoption of SGLT2i and other cardioprotective agents through a multifaceted approach, aiming to improve real-world adoption for patients with T2D and/or cardiovascular and kidney diseases.