Abstract
Background: Despite strong evidence of benefit, uptake of newer glucose-lowering medications that reduce cardiovascular risk has been poor. We examined global trends and predictors of use of SGLT2i and GLP-1 RA in patients with T2D. Methods: DISCOVER is a global, prospective, observational study of patients with T2D enrolled from 2014-16 at initiation of 2nd-line glucose-lowering therapy and followed for 3 years. We used hierarchical logistic regression to examine factors associated with use of either SGLT2i or GLP-1 RA at 3 years. Results: Among 14,576 patients from 37 countries, 1579 (10.8%) were started on an SGLT2i (8.7%) or GLP-1 RA (2.2%) at enrollment as 2nd-line therapy. This increased to 16.1% at end of follow-up (13.5% SGLT2i, 3.3% GLP-1 RA). Median use across the 37 countries at 3 years was 19.4% (IQR 8.7-30.6%; range 0-62.7%). Younger age, male sex, higher BMI, and coronary disease were associated with higher use of SGLT2i/GLP-1 RA while peripheral artery disease and kidney disease were associated with lower use. Conclusions: Global use of glucose-lowering medications with cardiovascular benefits has increased over time (particularly SGLT2i) but remains suboptimal, particularly in sub-groups most likely to benefit. Substantial country-level variability exists independent of patient factors, suggesting structural barriers may limit more widespread use of these medications. Disclosure S. V. Arnold: None. K. Khunti: Advisory Panel; Self; Amgen Inc., AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Berlin-Chemie AG, Lilly Diabetes, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novo Nordisk, Roche Pharma, Sanofi-Aventis. M. N. Kosiborod: Consultant; Self; Amgen Inc., Applied Therapeutics, AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Scientific Affairs, LLC., Merck & Co., Inc., Novo Nordisk, Sanofi, Vifor Pharma Management Ltd., Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH. F. Tang: Other Relationship; Self; AstraZeneca. A. Cooper: Employee; Self; AstraZeneca. H. Chen: None. M. B. Gomes: None. W. Rathmann: Advisory Panel; Self; AstraZeneca, Research Support; Self; Novo Nordisk. I. Shimomura: Advisory Panel; Self; AstraZeneca K. K., Daiichi Sankyo, Novo Nordisk Pharma Ltd., Taisho Pharmaceutical Co., Ltd., Consultant; Self; MSD K. K., Novo Nordisk Pharma Ltd., Research Support; Self; Astellas Pharma Inc., Daiichi Sankyo, Eli Lilly Japan K. K., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K. K., Novartis Pharma K. K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K. K., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited, Speaker’s Bureau; Self; Astellas Pharma Inc., AstraZeneca K. K., Daiichi Sankyo, Eli Lilly Japan K. K., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K. K., Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K. K., Sanwa Kagaku Kenkyusho, Taiho Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. J. Vora: Advisory Panel; Self; Bayer Inc., Other Relationship; Self; AstraZeneca. H. Watada: Research Support; Self; Abbott Japan Co., Ltd., Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kissei Pharmaceutical Co., Ltd., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD Corporation, Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Speaker’s Bureau; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Kyowa Kirin Co., Ltd., Lilly Diabetes, Mitsubishi Tanabe Pharma Corporation, MSD Corporation, Novo Nordisk, Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Terumo Corporation. Funding AstraZeneca
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