Abstract
Background: Evidence-based SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1 RA) reduce cardiovascular (CV) events and improve kidney outcomes in patients with type 2 diabetes (T2D) who are at elevated cardiac or renal risk; however, prescription rates are low despite guidelines recommending their use. We aimed to evaluate the eligibility for, and utilization of, SGLT2i and GLP-1 RA in real-world practice in a large, integrated, multicenter health system. Aim: To determine the prevalence of CV and kidney comorbidities in patients with T2D and current medication use patterns within a large, urban healthcare system. Methods: In this cross-sectional analysis of the Mass General Brigham healthcare system from 2020-2023, we identified all patients with T2D meeting current guideline eligibility criteria for SGLT2i and/or GLP-1 RA. Indications for therapy included ASCVD, heart failure, kidney disease, or high risk for developing ASCVD - determined by EHR data. High risk for developing ASCVD and ASCVD were mutually exclusive, however other indications were reported as identified comorbidities by patient. Demographics, medications, laboratory values, and comorbidities were assessed. Results: There were 304,105 people with T2D and an HbA1c within 3 years: mean age 70 years, HbA1c 7.1%, 52% male, 30% non-white, 11% non-English language preferred. 186,885 (62%) patients had > 1 CV or kidney comorbidity: 82,245 (44%) high risk for developing ASCVD, 90,408 (48%) ASCVD, 29,766 (16%) HF, 46,801 (25%) kidney disease, and 50,825 (27%) with > 2 comorbidities. Of the 186,885 patients with an indication, 21,997 (12%) were prescribed an SGLT2i, 28,620 (15%) a GLP-1 RA, and 7,544 (4%) both ( Figure 1 .) Conclusion: Ongoing limited use of agents with proven CV and kidney benefit exists among commonly encountered patients with T2D despite guideline recommendations; novel strategies are needed to overcome the barriers that keep patients from improved outcomes.
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