Abstract 13544: Cardiologist Underutilization of New Antihyperglycemic Medications in Diabetic Patients With Cardiovascular Disease

Abstract

Introduction: Sodium Glucose Cotransporter-2 inhibitors (SGLT2i) and Glucose-Like Peptide-1 receptor agonists (GLP-1ra) showed significant reduction in cardiovascular (CV) events in type 2 diabetes (T2DM) patients (pts). The ADA and ACC recommend using SGLT2i/GLP-1ra in CV patients with T2DM (T2DM-CV). This study evaluated prescribing patterns in T2DM-CV to distinguish characteristics between those pts receiving SGLT2i/GLP-1ra from those not receiving SGLT2i/GLP-1ra. Hypothesis: SGLT2i/GLP-1ra are underutilized in T2DM-CV pts. Methods: Ochsner Health’s EPIC database was queried for T2DM-CV pts treated between Jan 2016 - Dec 2018. Baseline demographics and clinical characteristics were compared using ANOVA for numerical covariates, χ-square test for categorical covariates and multivariate logistic regression. Results: A total of 4,741 T2DM-CV pts were identified with approved indication for SGLT2i/GLP-1ra. Only 686 received a prescription for one of the approved SGLT2i/GLP-1ra with CV indication at the time of the study (empagliflozin, canagliflozin, liraglutide). Pts receiving SGLT2i/GLP1-ra were younger, had higher BMI, A1c, hypertension, hypercholesteremia, and/or commercial insurance or self-pay. Pts with CAD, atrial fibrillation, prior TIA or stroke, or heart failure were less likely to receive these drugs. (Table) Cardiologists rarely prescribed SGLT2i/GLP-1ra (2.2%) compared with primary care physicians (PCP) (45.6%) or endocrinologists (44.6%) (p<0.001). Conclusions: T2DM-CV pts rarely received guideline directed SGLT2i/GLP-1ra, and cardiologists rarely prescribed them. Younger pts with higher A1c, CV risk factors, and commercial insurance were more likely to be prescribed SGLT2i/GLP-1ra than pts with CV disease, despite reduction in CV events in randomized trials and societal guidelines. Cardiologists need to work with endocrinologists and PCPs to drive use of these medications to improve outcomes in T2DM-CV pts.