Use of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagonlike Peptide-1 Receptor Agonists in Patients With Diabetes and Cardiovascular Disease in Community Practice

Abstract

ImportanceRecent national guidelines recommend sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD); yet, there are limited data on the use of these agents in contemporary community practice.ObjectiveTo evaluate the use of SGLT2i and GLP-1 RA in adults with T2D and ASCVD across a diverse sample of health care systems in the US.Design, Setting, and ParticipantsThis multicenter, retrospective cohort study used electronic health record data from 88 US health care systems participating in Cerner Real World Data between January 2018 to March 2021. Adults with ASCVD and T2D taking at least 1 glucose-lowering medication, had end-stage kidney disease, or had stage 5 chronic kidney disease were excluded.Main Outcomes and MeasuresTreatment with SGLT2i or GLP-1 RA.ResultsA total of 321 304 patients were identified with T2D and ASCVD ASCVD (130 280 female [40.5%]; median [IQR] age, 70.9 [62.9-78.0] years) who were potentially eligible for SGLT2i and/or GLP-1 RA, including 37 754 Black individuals (11.8%), 51 522 Hispanic individuals (16.0%), and 256 008 White individuals (11.8%). From January 2018 to March 2021, the use of SGLT2i increased from 5.8% (11 285 of 194 264) to 12.9% (11 058 of 85 956), GLP-1 RA increased from 6.9% (13 402 of 194 264) to 13.8% (11 901 of 85 956), and use of either agent increased from 11.4% (22 069 of 194 264) to 23.2% (19 909 of 85 956). Those taking an SGLT2i or GLP-1 RA were younger, less frequently hospitalized in the year prior, and more likely to be taking additional secondary prevention medications. Treated and nontreated populations were similar in terms of race, ethnicity, and outpatient health care utilization. Sulfonylureas and dipeptidyl peptidase 4 inhibitors remained more commonly used than SGLT2i or GLP-1 RA through 2021.Conclusions and RelevanceIn this study, uptake of SGLT2i and GLP-1 RA in adults with T2D and ASCVD increased modestly after guideline recommendations, although less than a quarter of persons with ASCVD and T2D receiving medical therapy were taking either. Further efforts are necessary to maximize the potential population benefit of these therapies in this high-risk population.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…Among 321 304 patients with type 2 diabetes and ASCVD in 88 US health care systems, from January 2018 to March 2021, the use of SGLT-2 inhibitors increased from 5.8% to 12.9% and the use of GLP1-RAs from 6.9% to 13.8% (and either agent from 11.4% to 23.2%). 100 Those taking either of these agents were younger, less likely to have been hospitalized in the past year, and more likely to be taking other secondary prevention medications.…”

Integrated analysis for treatment scheme of sodium–glucose cotransporter 2 inhibitors in patients with diabetic kidney disease: a real-world study

“…Our study found that, although the proportion of SGLT2i increased year by year, the overall utilization rate of SGLT2i was low in DKD patients. Previous studies have also found low rates of SGLT2i use, partly due to the high out-of-pocket costs associated with SGLT2i as a new drug 20 , 21 . In China, on the other hand, SGLT2i were about four times less expensive than before, following their inclusion in health insurance in November 2019.…”

Studying and learning

“…Dipeptidyl peptidase 4 inhibitors were used by 15%-18%, and, although the most use was of metformin (60%) and sulfonylureas (25%-30%), the doubling of use of SGLT2i and GLP-1RA suggests a real change in practice patterns. 5…”

“…An electronic health record analysis of >300 000 persons with type 2 diabetes and CVD found that use of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) and glucagonlike peptide‐1 receptor agonists (GLP‐1RA) increased from ~11% in 2018 to 23% in 2021. Dipeptidyl peptidase 4 inhibitors were used by 15%–18%, and, although the most use was of metformin (~60%) and sulfonylureas (25%–30%), the doubling of use of SGLT2i and GLP‐1RA suggests a real change in practice patterns 5 …”