Prescription Patterns of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists in Patients with Coronary Artery Disease

Hofer, Felix; Kazem, Niema; Schweitzer, Ronny; Hammer, Andreas; Jakse, Friedrich; Koller, Lorenz; Hengstenberg, Christian; Sulzgruber, Patrick; Niessner, Alexander

doi:10.1007/s10557-021-07160-8

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…11 However, several studies have shown that a substantial proportion of eligible high-risk individuals are still not receiving cardiovascular beneficial therapies, but only therapies such as SUs, insulin and DPP-4is. 5,[12][13][14] In many countries including Denmark, most people with type 2 diabetes are followed in primary care (> 80% are treated in general practice in Denmark), whereas individuals with significant complications to diabetes or complex type 2 diabetes disease are often treated by diabetes specialists or other specialist physicians, typically in collaboration with general practice. 15 The increasing number of type 2 diabetes treatment modalities and frequent multimorbidity in type 2 diabetes poses a huge challenge for all involved healthcare personnel across healthcare systems.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, the number of users of these newer organ-protective, glucose-lowering drugs increased markedly during 2020-2021. However, based on known prevalences of cardiovascular disease and chronic kidney disease in people with type 2 diabetes,5,[12][13][14] data indicate that there are still many individuals who do not receive effective, adequate, modern and individualized treatment. The vast majority of people with type 2 diabetes are treated in general practice, which is in line with Danish recommendations.…”

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confidence: 99%

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Changes in the use of glucose‐lowering drugs: A Danish nationwide study

Pottegård

Andersen

Søndergaard

et al. 2023

Diabetes Obesity Metabolism

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Aim To investigate changes in the pattern of drugs used to treat type 2 diabetes in Denmark from 2005 to 2021. Materials and Methods A nationwide, population‐based drug utilization study based on medical databases covering the Danish population was conducted. We assessed incident and prevalent use patterns among all 441 205 individuals initiating at least one non‐insulin, glucose‐lowering drug. Results The rate of new users of non‐insulin, glucose‐lowering drugs increased from 2005, peaked in 2011, decreased to stable levels during 2013 to 2019, then increased dramatically during 2020‐2021. The prevalence of use increased from 2.1% (in 2005) to 5.0% (in 2021) of the entire adult population. In 2021, metformin comprised 39% of all glucose‐lowering drug consumption, followed by insulin (17%), sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2is) (17%), glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) (16%) and dipeptidyl peptidase‐4 inhibitors (7.5%). Overall, 56% of users were on monotherapy, 28% used dual therapy, while 13% and 2.8% used three and four drug classes, respectively. Both the intensity and diversity of therapies increased substantially over time, with 15 different treatment regimens each covering more than 1% of users in 2021. General practitioners prescribed 88% of all glucose‐lowering drugs. Marked shifts towards GLP‐1RA initiation by general practitioners and SGLT‐2i initiation by specialists were observed, and changing user profiles suggested increasing use for non‐diabetes indications. Conclusions The rate of new users of non‐insulin, glucose‐lowering drugs has increased in recent years and the prevalence of glucose‐lowering drug use increases steadily. Glucose‐lowering drugs are mainly prescribed by general practitioners, and the intensity, diversity and indications of glucose‐lowering treatment are increasing.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Changes in the use of glucose‐lowering drugs: A Danish nationwide study

Pottegård

Andersen

Søndergaard

et al. 2023

Diabetes Obesity Metabolism

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“…However, a substantial proportion of eligible high‐risk patients are still not receiving CV beneficial therapies. Throughout nationalities and country‐dependent healthcare systems, less than 15% of patients with T2D and CVD receive an SGLT‐2i or GLP‐1RA 11‐16 . The use of SGLT‐2i increased from 2.2% in 2014 to 40.9% in 2020 in patients with T2D and coronary artery disease, but the use of GLP‐1RA only increased from 1.1% to 9.1% 14 .…”

Section: Introductionmentioning

confidence: 99%

“…Throughout nationalities and country‐dependent healthcare systems, less than 15% of patients with T2D and CVD receive an SGLT‐2i or GLP‐1RA 11‐16 . The use of SGLT‐2i increased from 2.2% in 2014 to 40.9% in 2020 in patients with T2D and coronary artery disease, but the use of GLP‐1RA only increased from 1.1% to 9.1% 14 . SGLT‐2i are easy to prescribe and require less titration, and they have been more successfully implemented in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Understanding the place for GLP‐1RA therapy: Translating guidelines for treatment of type 2 diabetes into everyday clinical practice and patient selection

Andreasen

Andersen

Knop

et al. 2021

Diabetes Obesity Metabolism

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Since the first glucagon‐like peptide 1 (GLP‐1) receptor agonist (GLP‐1RA) was approved in 2005 (exenatide twice daily) for type 2 diabetes (T2D), the class has developed with newer compounds having more pronounced effects on glycaemic control and body weight. Also, administration regimes have become more convenient with once weekly injections, and recently an oral administration has become available. Large‐scale randomized controlled cardiovascular (CV) outcome trials (CVOTs) have shown that GLP‐1RA therapy can reduce the risk of CV disease (CVD) in high‐risk individuals with T2D. In addition, GLP‐1RAs may have renal benefits driven by new‐onset macroalbuminuria, although no effect on hard renal endpoints has been found. Subsequently, the place for GLP‐1RA therapy has changed over recent years, with most societies endorsing GLP‐1RA therapy in patients with established or high risk of CVD independently of glycaemia. Initiation of GLP‐1RA therapy can be complex due to differences in efficacy, side effects and safety profiles as well as administration forms within the class. Implementing guideline recommendations into ideal patient selection may be challenging both in specialty and non‐specialty settings. To ensure adequate and proactive use of modern glucose‐lowering medications in the treatment of T2D, it is essential to recognize patients with high risk or documented CVD. The present review provides an overview of the efficacy and benefits of the currently available GLP‐1RA compounds. Furthermore, we review the results from recent large‐scale CVOTs in a clinical context and suggest improving the implementation of GLP‐1RA therapy across specialties to improve overall patient selection.

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“…In CABG patients, T2DM is independently associated with future cardiovascular risk 5 , thus, surgery provides an opportunity to initiate guideline-directed care. Therefore, it is unfortunate that the overall prescription rates among CABG patients are not higher than T2DM with stable coronary artery disease 6 . While the observed 20-fold increase in SGLT2i use over a four-year study period is encouraging, two thirds of patients with T2DM undergoing CABG remained untreated with either recommended drug, suggesting a significant opportunity to improve cardiovascular outcomes in this high-risk group.…”

Section: Discussionmentioning

confidence: 99%

Trends in Prescriptions of Cardioprotective Diabetic Agents After Coronary Artery Bypass Grafting Among U.S. Veterans

et al. 2022

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OBJECTIVE Patients with type 2 diabetes undergoing coronary artery bypass grafting (CABG) are at risk for cardiovascular events. Sodium–glucose cotransporter 2 receptor inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) are effective cardioprotective agents; however, their prescription among CABG patients is uncertain. The aims of this study were 1) to evaluate the overall use of SGLT2i/GLP-1RA after CABG and explore longitudinal trends and 2) to examine patient-related factors associated with the use of SGLT2i or GLP-1RA. RESEARCH DESIGN AND METHODS We analyzed the nationwide Veterans Affairs (VA) database (2016–2019) to report trends and factors associated with SGLT2i or GLP-1RA prescription after CABG. RESULTS Among 5,109 patients operated on at 40 different VA medical centers, 525 of 5,109 (10.4%), 352 of 5,109 (6.8%), and 91 of 5,109 (1.8%) were prescribed SGLT2i, GLP-1RA, and both, respectively. A substantial increase in the quarterly SGLT2i prescription rates (1.6% [first quarter of 2016 (2016Q1)], 33% [2019Q4]) was present but was lower for GLP-1RA (0.8% [2016Q1], 11.2% [2019Q4]). SGLT2i use was less likely with preexisting vascular disease (odd ratio [OR] 0.75, 95% CI 0.75, 0.94) or kidney disease (OR 0.72, 95% CI 0.58, 0.88), while GLP-1RA use was associated with obesity (OR 1.91, 95% CI 1.50, 2.46). CONCLUSIONS The overall utilization of SGLT2i or GLP-1RA drugs in U.S. veterans with type 2 diabetes undergoing CABG is low, with SGLT2i preferred over GLP-1RA.

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Prescription Patterns of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists in Patients with Coronary Artery Disease

Cited by 5 publications

References 14 publications

Changes in the use of glucose‐lowering drugs: A Danish nationwide study

Changes in the use of glucose‐lowering drugs: A Danish nationwide study

Understanding the place for GLP‐1RA therapy: Translating guidelines for treatment of type 2 diabetes into everyday clinical practice and patient selection

Trends in Prescriptions of Cardioprotective Diabetic Agents After Coronary Artery Bypass Grafting Among U.S. Veterans

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