Background: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium glucose cotransporter-2 inhibitors (SGLT2i) have cardioprotective and kidney-protective effects in select patients with type-2 diabetes (T2D) . Appropriate use, and cost-effectiveness, is essential to realize these benefits as well as to manage total healthcare spending.

Methods: For a commercially insured population (≥18 years old) enrolled in a virtual accountable care organization (Level2) , we examined de-identified administrative claims in a research database for Type-2 diabetes medications from 12/01/20to 11/30/2021. We determined the TCoC for this population, as well as changes in spending and utilization by medication class.

Results: Among 7,361 individuals attributed to Level2, 1,735 members (23.6%) had a cardiovascular or renal indication for an GLP-1RA or SGLT2i. In this population, 447 were prescribed a GLP-1RA and 385 were prescribed a SGLT2i, representing 25.8% and 22.2% of those with comorbidity indications for each drug, respectively. Additionally, 1,214 individuals were prescribed a GLP-1RA and 1,214 were prescribed a SGLT2i without cardiovascular or renal indications, representing 35% of these prescriptions combined.

Conclusion: In 2019-21, use of GLP-1RA and SGLT2i remained limited to approximately 1 in 4 commercially insured patients with T2D and a cardiovascular or renal indication for their selection. Further, they were commonly used in the absence of cardiovascular or renal indication for these classes of agents. While nondiabetes indications for these drugs (weight-loss and renal disease) have expanded recently (April-June 2021) , those broader indications were not in place for the majority of the study period. In a time of limited resources, guideline-concordant therapy is critical to improving the health of those with indications as well as reducing less-than-appropriate use.


D.J.Cook: None. A.Defail: Employee; Level2. E.Macfarlane: Employee; Level2. D.Pederson: Employee; Level2.

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