Introduction: In people with T2D and preexisting ASCVD, either SGLT2i or GLP1RA are indicated by treatment guidelines to reduce MACE. We evaluated predictors of prescription of SGLT2i vs GLP1RA in a population eligible for either.
Methods: An electronic health record (EHR) based registry was created to identify people with T2D and ASCVD who were indicated either a GLP1RA or SGLT2i for cardiorenal protection within a large, academic health system. Data pertaining to demographics, lab and imaging results, ICD9/10 diagnoses, prescriptions, provider and clinic characteristics were extracted. Eligible encounters occurred in a primary care, endocrinology, cardiology, or nephrology clinic between January 1, 2019 and August 23, 2023. For each eligible encounter where a drug was prescribed, the first treatment type (GLP1RA or SGLT2i) was determined based on medication history. We estimated a logistic regression using stepwise variable selection to identify a best-predicting model and forced the variables of age, sex, and race into the model.
Results: A total of 315 patients with T2D and ASCVD were eligible for either treatment and were prescribed one of these medications: 142 were prescribed a GLP1RA and 173 were prescribed SGLT2i. Lower BMI was associated with use of SGLT2i (OR = 0.91, 95% CI 0.87-0.96), as was being an established patient (OR 2.32, 95% CI 1.14-4.72). Compared to treatment in a primary care setting, treatment in a cardiology clinic was strongly associated with prescription of SGLT2i (OR = 7.77, 95% CI 3.18-19.04), whereas treatment in endocrinology clinic was strongly associated with prescription of a GLP1RA (OR = 0.35, 95% CI 0.18-0.68). Area under the receiver operating characteristic curve for the model was 0.82.
Conclusion: In a real-world dataset from a large academic center, the selection of guideline directed therapy for patients with T2D and ASCVD was strongly determined by the provider’s specialty, highlighting an important opportunity for education.
S. Agarwal: None. M.A. Basit: None. M.E. Bowen: Research Support; Boehringer-Ingelheim. D. Heitjan: Consultant; Bluejay Diagnostics, Medcognetics, Sebela, Abbott, Macrogenics, Guardant, Bristol-Myers Squibb Company, Gilead Sciences, Inc. C. Mai: None. K. Marble: None. Z. Xiang: None. I. Lingvay: Consultant; Altimmune, Astra Zeneca, Bayer, Biomea, Boehringer-Ingelheim, Carmot, Cytoki Pharma, Eli Lilly, Intercept, Janssen/J&J, Mannkind, Mediflix, Merck, Metsera, Novo Nordisk, Pharmaventures, Pfizer, Sanofi. Research Support; NovoNordisk, Sanofi, Mylan, Boehringer-Ingelheim. Consultant; TERNS Pharma, The Comm Group, Valeritas, WebMD, and Zealand Pharma.
This study was supported by Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI) and Lilly USA, LLC. The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE) and were fully responsible for all aspects of the trial and publication development.
