Clinical Decision Support for SGLT2i After AKI in Type 2 Diabetes

Sodium-glucose co-transporter-2 inhibitors are FDA-approved medications for type 2 diabetes and have been shown to reduce kidney and cardiovascular risks in several patient populations. However, providers may be hesitant to prescribe SGLT2 inhibitors to patients who have recently experienced acute kidney injury because of concerns about kidney function changes after initiation. This study is a pilot adaptive cluster randomized clinical trial conducted in participating M Health Fairview primary care clinics. Clinics will be randomized 1:1 to receive a clinical decision support intervention or continue usual care. The intervention consists of a message sent to the primary care provider or clinic pharmacist before a scheduled encounter with an eligible patient. Eligible patients will be adults aged 30 to 75 years with type 2 diabetes, a history of acute kidney injury during a hospitalization with discharge within the prior year, and kidney function meeting study criteria. The study team will not provide SGLT2 inhibitors or direct treatment. All prescribing decisions, including whether to prescribe an SGLT2 inhibitor and which medication to use, will remain with the patient's usual provider and clinical care team. The adaptive component applies only within the intervention arm. Patients in intervention clinics who attend a qualifying encounter but have no evidence of SGLT2i consideration may be randomized before a later qualifying encounter to receive either no further CDS messages or additional CDS messages. The primary focus of this pilot study is feasibility. Outcomes will be collected from the electronic health record and the AHC/M Health Fairview data shelter. Feasibility outcomes include the number of eligible patients identified, CDS messages sent, providers or pharmacists receiving messages, patients with SGLT2i mentioned or prescribed, patients with follow-up kidney function data, and patients undergoing the second adaptive randomization step.