Objective: To investigate the knowledge, use and barriers when prescribing GLP-1RA and SGLT2i among cardiologists, endocrinologists and general practitioners, and explore the influencing factors that hinder the use of these medications. Methods: A questionnaire was conducted among physicians in the above departments in Peking University Third Hospital and health service institutions at all levels in its medical consortium. A total of 342 physicians were involved. Among them, 40.6% (139) were cardiologists, 28.9% (99) were endocrinologists and 30.4% (104) were general practitioners; 66.7% (270) came from Beijing while 33.3% (72) from other provinces. The survey included clinicians' knowledge and current use of GLP-1RA and SGLT2i, and the possible reasons that influenced the prescription of these medications. Medical therapies of physicians were investigated by simulating different clinical scenarios. The difference of measures among physicians in different departments was compared. Results: A total of 342 physicians were involved, with the average age of 40 (35, 46) years old and the average working time of 13 (7, 20) years. Among them, 40.6% (139) were male. 77.5% (265) physicians had comprehensive knowledge of SGLT2i and prescribed it, which was higher than that for GLP-1RA (70.5%, 241) (P<0.001). 21.1% (72) physicians prescribed SGLT2i more than 20 times per month, which was higher than that for GLP-1RA (8.2%, 28) (P<0.001). Endocrinologists had more knowledge and prescribed more GLP-1RA and SGLT2i compared with other physicians (both P values<0.001). 38.1% (53) cardiologists, 22.2% (22) endocrinologists, and 30.8% (32) general practitioners believed patients needed an endocrinologist to evaluate and adjust GLP-1RA, which was the primary barrier for the use of medications (P=0.042). 27.4% (38) cardiologists, 14.1% (14) endocrinologists, and 30.8% (32) general practitioners believed patients needed an endocrinologist to evaluate and adjust SGLT2i, which was the primary barrier for the use of medications (P=0.018). 21.6% (30) cardiologists, 45.5% (45) endocrinologists, and 31.7% (33) general practitioners believed side effects of SGLT2i was the primary barrier for the use of medications (P<0.001). For patients with unqualified glycemic control and cardiovascular complications, 65.4% (75) cardiologists, 69.7% (69) endocrinologists, and 43.3% (45) general practitioners chose the above medications (P<0.001). For patients with qualified glycemic control, combined with cardiovascular complications and diabetic organ damage, 35.3% (49) cardiologists, 52.5% (52) endocrinologists, and 25.0% (26) general practitioners chose the above medications (P<0.001). Conclusions: Physicians had more knowledge and prescription of SGLT2i than that of GLP-1RA. Endocrinologists had more knowledge and prescription of the above medications than other physicians. The side effect of medications was potential primary barrier for the use of the novel hypoglycemic agent with cardiovascular benefits. In clinical practice, most of physicians considered that high-risk patients with cardiovascular comorbidities need to be referred to cardiologist or endocrinologist to adjust clinical therapies.
目的： 调查心血管内科、内分泌科、综合内科医师对有心血管获益的新型降糖药物胰高糖素样肽1受体激动剂（GLP-1RA）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）的认知程度和处方情况，以及阻碍上述药物使用的首要因素。 方法： 本研究为问卷调查，选择2022年1月1日至6月30日北京大学第三医院及其医联体内、心血管内科进修学员所在单位的心血管内科、内分泌科、综合内科医师为调查对象，不限制参与医师的年龄、从医年限及职称，对其进行问卷调查，最终纳入342名医师，其中心血管内科139名（40.6%）、内分泌科99名（28.9%）、综合内科104名（30.4%）；来自北京市270名（66.7%），京外72名（33.3%）。调查内容主要包括对GLP-1RA和SGLT2i的认知程度及处方情况，影响使用的首要因素，同时通过模拟2个临床情景，调查医师对治疗方案的选择，比较不同科室间上述指标的差异。 结果： 342名医师的年龄为40（35，46）岁，从医年限13（7，20）年，其中男性139名（40.6%）。77.5%（265名）医师了解SGLT2i适应证等信息并处方过该药物，高于GLP-1RA的70.5%（241名）（P<0.001）；21.1%（72名）医师每月处方SGLT2i>20次，高于GLP-1RA的8.2%（28名）（P<0.001）。不同科室医师对GLP-1RA的认知程度和处方频率不同，内分泌科医师较高（均P<0.001），不同科室医师对SGLT2i的处方频率不同，内分泌科医师较高（P<0.001）。38.1%（53名）心血管内科医师、22.2%（22名）内分泌科医师和30.8%（32名）综合内科医师认为患者应该去专科评估是否换用GLP-1RA是影响药物应用的首要因素（P=0.042）；27.4%（38名）心血管内科医师、14.1%（14名）内分泌科医师和30.8%（32名）综合内科医师认为患者应该去专科评估是否换用SGLT2i是影响药物应用的首要因素（P=0.018）；21.6%（30名）心血管内科医师、45.5%（45名）内分泌科医师、31.7%（33名）综合内科医师认为患者因不良反应不能坚持用SGLT2i是影响药物应用的首要因素（P<0.001）。对于血糖控制未达标且合并心血管并发症的患者，65.4%（75名）心血管内科医师、69.7%（69名）内分泌科医师、43.3%（45名）综合内科医师选择加用GLP-1RA和SGLT2i（P<0.001）；对于血糖控制达标、合并心血管并发症及糖尿病靶器官损害的患者，35.3%（49名）心血管内科医师、52.5%（52名）内分泌科医师、25.0%（26名）综合内科医师选择加用GLP-1RA和SGLT2i（P<0.001）。 结论： 医师对SGLT2i的认知程度及处方频率均高于GLP-1RA；内分泌科医师对GLP-1RA和SGLT2i的认知程度和处方频率较高。药物不良反应等是影响医师使用有心血管获益的降糖药物首要因素。多数医师认为，糖尿病患者合并冠心病时，需要转诊至不同专科调整相应治疗方案。.