Real‐world use of cardioprotective glucose‐lowering drugs in patients with type 2 diabetes and cardiovascular disease: A Danish nationwide cohort study, 2012 to 2019

Abstract

Aims To investigate temporal trends in time to initiation of sodium‐glucose co‐transporter‐2 inhibitors and glucagon‐like peptide 1 analogues (cardioprotective glucose‐lowering drugs [GLDs]) in patients with a new dual diagnosis of type 2 diabetes (T2DM) and cardiovascular disease (CVD). Materials and methods In a cohort study, we identified patients with a new dual diagnosis of T2DM and CVD using linked healthcare data from nationwide registries on drug prescriptions and diagnosis codes. For each calendar year between 2012 and 2018, we examined time to initiation and cumulative user proportions (CUPs) for cardioprotective GLD use 1 and 2 years after the dual diagnosis. Results Among all individuals living in Denmark in the period 2012 to 2018, 41 733 patients with a new dual diagnosis of T2DM and CVD were identified (median [interquartile range] age 71 [64–79] years, 61% male, and 57% with CVD as the latest diagnosis). Incidence curve slopes and 1‐ and 2‐year CUPs for cardioprotective GLDs increased during the study period (1‐year CUP 4.0%, 95% confidence interval [CI] 3.6–4.5) in 2012 to 14.7, 95% CI 13.7–15.7, in 2018; 2‐year CUP 5.5, 95% CI 5.0–6.1, in 2012 to 16.7, 95% CI 15.8–17.7, in 2017). T2DM patients with CVD as the second (latest) diagnosis had higher 1‐year CUPs than CVD patients with T2DM as the latest diagnosis: 2012: 7.0 (95% CI 6.2–8.0) versus 1.4 (95% CI 1.0–1.8); 2018: 18.1 (95% CI 16.8–19.6) versus 10.0 (95% CI 8.8‐11.3). Conclusions In patients with T2DM and CVD, the incidence of cardioprotective GLD initiation increased between 2012 and 2018, however, within 2 years of dual diagnosis, it remained low.

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

“…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 .…”

Glucagon-Like Peptide 1 Receptor Agonist Usage in Type 2 Diabetes in Primary Care for the UK and Beyond: A Narrative Review

“…Despite the CV benefits of some GLP-1 RAs [34][35][36][37][38], there was no difference in the prescribing rates of GLP-1 RAs between people with and without CV disease history [30]. In a Danish nationwide cohort study in people with a new dual diagnosis of T2D and CV disease, the number of people prescribed a GLP-1 RA within a year of diagnosis increased from 3.9% in 2012 to 8.1% in 2018 [31]. Similarly, on the basis of dispensing data from the Netherlands in people with T2D, the prevalence of treatment with GLP-1 RAs was low (1.2%) between 2012 and 2017, although it did show an increasing trend over time [33].…”

“…Long-acting GLP-1 RAs include liraglutide (with a half-life of 13 h), exenatide OW (a prolonged-release formulation of the active drug from poly[D,L-lactide-co-glycolide] microspheres) and dulaglutide (with a half-life of 4.7 days) [21,22], and s.c. semaglutide formulation (with a half-life of 7 days) [6,29]. Over the last decade, although the prescription of GLP-1 RAs has increased slightly, overall usage remains low compared with other glucose-lowering medications, such as metformin, sulfonylureas and dipeptidyl peptidase 4 inhibitors (DPP4i), regardless of CV disease status [30][31][32][33]. A UK analysis described class-level prescribing of glucose-lowering medications in people with T2D and showed a small increase in the prescription of GLP-1 RA from 2017 to 2020 [30].…”

Preventing all‐cause hospitalizations in type 2 diabetes with sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists: A narrative review and proposed clinical approach

“…12 Position statements recommend DMD treatment independently of glucose control or background metformin use in patients with T2D and increased cardiorenal risk, [73][74][75] yet their use amongst appropriate patients remains low. 68,76,77 Cumulating post hoc analyses of RCTs and RWE suggest that DMDs can also improve prognosis in those with T2D and lower cardiorenal risks 17,24,25,40,[78][79][80][81][82][83] (Figures 1 and 2).…”