National Trends in Use of Sodium‐Glucose Cotransporter‐2 Inhibitors and Glucagon‐like Peptide‐1 Receptor Agonists by Cardiologists and Other Specialties, 2015 to 2020

Abstract

Background Sodium‐glucose cotransporter‐2 inhibitors (SGLT2is) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) mitigate cardiovascular risk in individuals with type 2 diabetes, but most eligible patients do not receive them. We characterized temporal trends in SGLT2i and GLP‐1RA use by cardiologists compared with other groups of clinicians. Methods and Results We conducted a descriptive analysis of serial, cross‐sectional data derived from IQVIA’s National Prescription Audit, a comprehensive audit capturing ≈90% of US retail prescription dispensing and projected to population‐level data, to estimate monthly SGLT2is and GLP‐1RAs dispensed from January 2015 to December 2020, stratified by prescriber specialty and molecule. We also used the American Medical Association’s Physician Masterfile to calculate average annual SGLT2is and GLP‐1RAs dispensed per physician. Between January 2015 and December 2020, a total of 63.2 million SGLT2i and 63.4 million GLP‐1RA prescriptions were dispensed in the United States. Monthly prescriptions from cardiologists increased 12‐fold for SGLT2is (from 2228 to 25 815) and 4‐fold for GLP‐1RAs (from 1927 to 6981). Nonetheless, cardiologists represented only 1.5% of SGLT2i prescriptions and 0.4% of GLP‐1RA prescriptions in 2020, while total use was predominated by primary care physicians/internists (57% of 2020 SGLT2is and 52% of GLP‐1RAs). Endocrinologists led in terms of prescriptions dispensed per physician in 2020 (272 SGLT2is and 405 GLP‐1RAs). Cardiologists, but not noncardiologists, increasingly used SGLT2is over GLP‐1RAs, with accelerated uptake of empagliflozin and dapagliflozin coinciding with their landmark cardiovascular outcomes trials and subsequent US Food and Drug Administration label expansions. Conclusions While use of SGLT2is and GLP‐1RAs by cardiologists in the United States increased substantially over a 6‐year period, cardiologists still account for a very small proportion of all use, contributing to marked undertreatment of individuals with type 2 diabetes at high cardiovascular risk.

Real-world national trends and socio-economic factors preference of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in China

“…Clinicians in different departments play an important role in the selection of new hyperglycemia medications. Similar with prior studies (14,37), our study suggests that cardiologists or nephrologists prefer prescribing SGLT2i over GLP-1RA compared to endocrinologists (Table 2). According to EASD/ ADA guideline (38), SGLT2i is preferably recommended for reducing HF and/or CKD progression in cardiovascular outcomes trials (CVOTs), which could be the potential reason for more favorable in the department of cardiology and nephrology.…”

SGLT2 Inhibitors: The Next Blockbuster Multifaceted Drug?

“…Creation of SGLT2i initiation guidelines can help prescribers and increase usage of SGLT2i. Currently, of all prescribers, endocrinologists lead with the highest prescription of SGLT2i therapy [ 52 , 53 ]. Cardiologists tended to use SGLT2i over GLP-1 receptor agonists, with increased usage coinciding with the landmark cardiovascular outcome trials.…”

Telehealth Intervention to Improve Uptake of Evidence-Based Medications among Patients with Type 2 Diabetes and Heart Failure or Cardiovascular Disease

“…Importantly, the prescribing of these medications has increased among cardiologists over time [ 6 ]. However, one survey conducted among general practitioners found that underprescribing of these medications could be related to an under-recognition of the benefits of these medications, lack of access to endocrinologists for consultation, and concerns with the medicines’ associated adverse events [ 7 ].…”