CONTEMPORARY NATIONAL PATTERNS OF ELIGIBILITY AND UTILIZATION OF NOVEL CARDIOPROTECTIVE ANTI-HYPERGLYCEMIC AGENTS IN TYPE 2 DIABETES

Abstract

Background Sodium glucose transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) effectively lowered cardiovascular risk in large clinical trials for patients with type 2 diabetes at high risk for these complications, and have recommended by guidelines. To evaluate the contemporary landscape in which these recommendations would be implemented, we examined the use of these medications according to clinical guideline practice. Methods and Results In the National Health and Nutrition Examination Survey for 2017-2018, we defined compelling indications for SGLT-2 inhibitors by the presence of atherosclerotic cardiovascular disease (ASCVD), heart failure, or chronic kidney disease (CKD), and for GLP-1RAs by the presence of established or high risk ASCVD, based on large clinical trials that have been incorporated in guideline recommendations of the American College of Cardiology (ACC) and American Diabetes Association (ADA). We then evaluated utilization of these medications among patients with physician-diagnosed type 2 diabetes. All analyses incorporated complex survey design to produce nationally representative estimates. A total 1104 of 9254 sampled individuals had type 2 diabetes, representing 10.6% (95% CI 9.7-11.6) of the US population or 33.2 million adults nationally. Of these, 52.6% (47.7-57.5) had an indication for SGLT-2 inhibitors, 32.8% (28.8-37.2) for GLP-1RAs, and 26.6% (22.2-31.7) for both medications. During 2017-2018, 4.5% (2.4-8.2) were treated with SGLT-2 inhibitors and 1.5% (0.7-3.2) with GLP-1RAs. ASCVD, heart failure, or CKD were not independently associated with SGLT-2 inhibitor or GLP-1RA use in patients with diabetes. Conclusions Despite a large number of patients being eligible for guideline recommended cardiorenal protective therapies, there are substantial gaps in the use of SGLT-2 inhibitors and GLP-1RAs, limiting their public health benefits.