Underprescription of SGLT2i and GLP-1 RA: CAREPRO-T2D (Cardiorenal Protection in Type 2 Diabetes) Cross-Sectional Study

Abstract

Background: New glucose-lowering drugs have shown benefits regarding cardiovascular events, heart failure, and kidney-related outcomes in type 2 diabetes (T2D). This study aimed to estimate the adequacy of SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1 RA) prescription to people living with T2D with established atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF). Material and methods: This was a cross-sectional study based on adults with T2D in a Portuguese local health unit between January 2019 and January 2020. Subjects with ASCVD were compared with subjects without ASCVD, and subjects with HF were compared with subjects without HF regarding clinical and demographic characteristics. Results: Our study included 13,869 adults with T2D, among whom 5.9% were coded for HF and 20.4% were defined as having ASCVD. SGLT2i were prescribed to 36.0% of subjects with HF. SGLT2i and/or GLP-1 RA were prescribed to 36.1% of patients with ASCVD. When comparing with subjects without ASCVD, subjects with ASCVD were significantly older (70.8 vs. 66.5 years, p<0.001), had lower estimated glomerular filtration rate (68.2 vs. 74.6 mL/min/1.73 m 2 , p<0.001), and higher rates of prescription of SGLT2i and/or GLP-1 RA (36.1 vs. 31.4%, p<0.001). When comparing with subjects without HF, subjects with HF were significantly older (74.6 vs. 66.9 years, p<0.001), had lower estimated glomerular filtration rate (59.6 vs. 74.1, mL/min/1.73 m 2 , p<0.001), and higher rates of prescription of SGLT2i (36.0 vs. 30.3%, p<0.001). Conclusion: SGLT2i and GLP-1 RA are underprescribed in T2D, with almost two-thirds of patients not being prescribed these agents despite being strongly advised by current guidelines. These findings highlight the need for specific actions to improve T2D management at primary care level.

Prescribing Patterns of SGLT2 inhibitors and GLP-1 receptor agonists in Patients with T2DM and ASCVD in South Korea

“…For those intolerant to dual oral agents, additional criteria such as BMI ≥ or contraindication to insulin were required. The extremely low utilization of GLP1RA compared with that in other countries [19,[23][24][25] could be explained by these strict insurance cover requirements. Government efforts to lower the insurance cover threshold for SGLT2i and GLP1RA are needed to ensure adequate utilization of these agents.…”

“…Despite these updated guidelines, global data have indicated insu cient utilization of SGLT2i and GLP1RA [18][19][20][21][22][23][24][25]. A nationwide study in the United States showed that the utilization rate of SGLT2i and GLP1RA increased between 2018 and 2021 in patients with T2DM and ASCVD; however, these agents remained underused in comparison with other antidiabetic agents, such as sulfonylureas (SU) and dipeptidyl-peptidase 4 inhibitors (DPP4i) [19].…”

Challenging the Restrictive Approach: Reconsidering Sodium-Glucose Transport Protein 2 Inhibitor Use in CKD

“…Several studies have repeatedly shown that gliflozins are underprescribed as of now. 4 Such limitations of sodium-glucose transport protein 2 inhibitors would obviously not benefit the current situation.…”