Objective: To describe use of GLP-1 RA and SGLT2i in the treatment of patients with diabetes and cardiovascular disease (CVD) using a large, clinical database.
Study Design: A retrospective descriptive analysis in a clinical database with 22 million longitudinal patient records across 22 health care organizations (HCOs).
Population Studied: A total of 2.6 million patients aged 18-75 with ≥ 2 ambulatory visits with primary care, endocrinology, cardiology, or nephrology in the past 18 months were included from 1/2013 to 3/2018. A subset of 350,000 patients with a type 2 diabetes (DM) diagnosis was observed during the 36 months ending 2016 Q1, 2017 Q1, 2018 Q1 for existing or new prescriptions of novel antidiabetic agents: GLP-1, SGLT2, or DPP-4. Patients were stratified by presence of cardiovascular disease (CVD), baseline DM medication regimen, and HbA1c ≥ 8.0, indicating need for advancing therapy.
Principal Findings: In 2018 Q1, the prevalence of CVD among patients with type 2 DM was 31%. Among patients with type 2 DM, a baseline oral antidiabetic regimen, and HbA1c ≥ 8.0, those with CVD were more likely to have any new DM medication class added (51% vs. 44%, p < 0.001), but no more likely than those without CVD to have a GLP-1 or SGLT2 added (p = 0.70). Patients with CVD were more likely to be prescribed insulin than those without evidence of CVD (20.2% vs. 10.3%, p < 0.001). From the 3-year period ending 2016 Q1 to that ending 2018 Q1, GLP-1 and SGLT2 prescriptions increased 3% and 4%, respectively, among all patients with type 2 DM.
Conclusions: Overall prescriptions of GLP-1 and SGLT2 are increasing but represent only 12% and 13%, respectively, of prescriptions for patients with type 2 DM (vs. 20% for DPP-4). Among patients with type 2 DM, these agents were prescribed no more frequently to those with established CVD than to those without CVD. Prescribing behavior complied with the new guidelines in only 14% of patients with both type 2 diabetes and CVD (range 8-31% across 20 HCOs).
C.R. Rattelman: None. E.L. Ciemins: None. J.K. Cuddeback: None.