Abstract 14678: Prevalence Of Sglt2 Inhibitor And Glp-1 Receptor Agonist Prescriptions In Patients With Comorbid Diabetes And Cardiovascular Disease In An Integrated Academic Health System

Abstract

Introduction: Multiple randomized clinical trials have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP1) receptor agonists reduce the risk of cardiovascular events and mortality in patients with type 2 diabetes (T2D) and cardiovascular disease (CVD). In order to inform implementation strategies, we sought to describe prescribing trends among patients with T2D in clinical practice. Methods: We developed a clinical T2D cohort using a validated computable phenotype from the electronic data warehouse of a large academic health system among patients receiving care from January 1, 2013 through December 31, 2019. We retrospectively reviewed outpatient prescribing patterns in this cohort, and stratified results by CVD subtype (heart failure [HF] and atherosclerotic CVD [ASCVD]). Results: There were 23,485 patients identified with T2D. Mean (SD) age was 67 years (13), 46% were women, 61% were white, 32% had comorbid CVD (HF or ASCVD), and the mean (SD) hemoglobin A1c was 8.0% (5.7%). The majority of SGLT2 inhibitors and GLP1 receptor agonists were first prescribed by endocrinologists, 52% and 65% respectively. The prescription rate for both medication classes was low, and though SGLT2 inhibitor use increased over time (1% in 2013 to 14% in 2019; p<0.01), GLP1 receptor agonist use did not significantly change (10% in 2013 to 10% in 2019; p=0.93). Among patients with HF, SGLT2 inhibitor and GLP1 receptor agonist use increased annually by 42% and 7%, respectively, while patients with ASCVD experienced year over year growth of 63% and 13% in these categories. See Figure 1 (A and B) for more detail. Conclusions: Prescription rates of SGLT2 inhibitors and GLP1 receptor agonists remains low, especially for patients with T2D and CVD, despite a proven reduction in mortality and cardiovascular events. Strategies to increase the use of these proven medical therapies represent a major opportunity to improve outcomes in this high-risk group.