Trends in initiation of GLP-1 RA in patients with type 2 diabetes during 2014–2019: a US database study

Abstract

Abstract Background/Introduction Evidence of cardiovascular (CV) benefit of certain glucagon-like peptide 1 receptor agonists (GLP-1 RAs) from CV outcomes trials (CVOTs) resulted in updates to international guidelines and label indications in patients with type 2 diabetes (T2D) at high CV risk. Purpose To evaluate the impact of new evidence, we investigated the incidence of new GLP-1 RA use and trends in prescriber and patient characteristics over a 5-year period encompassing key CVOT publications and an updated label indication. Methods Data from consecutive cross-sectional cohorts of patients with T2D and no GLP-1 RA prescription for ≥1 year prior to the start date, corresponding to each year between 2014 and 2019, were extracted retrospectively from US Optum's de-identified Clinformatics® Data Mart Database (2004–2020). For each year, incidence of new GLP-1 RA use, overall and according to prescriber speciality and the proportion of patients with atherosclerotic CV disease (ASCVD) among the new users were evaluated. Speciality was categorised using prescriber information within the database, while ASCVD was identified with ICD-9 CM or 10 CM codes reported prior to GLP-1 RA prescription or year-start date. Results During the study period, 2,966,970 eligible patients with T2D were identified, 108,541 of whom were new users of GLP-1 RAs. Overall incidence of new GLP-1 RA use increased each year, with a 3-fold increase in prescriptions from 727 to 2045 per 100,000 patient years between 2014 and 2019 (Figure a). Among new GLP-1 RA users, mean age was 60.1 years, increasing from 56.8 to 61.7 years. Mean HbA1c was 8.6% and was stable over time. Further analysis of new GLP-1 RA prescriptions identified family medicine as the greatest contributor to the absolute increase in incidence between 2014 and 2019, comprising nearly 40% of total prescriptions each year, whereas cardiology contributed the least, at <1% each year. The overall proportion of patients with ASCVD among those newly initiated on a GLP-1 RA and those initiated by a cardiology specialist increased after 2015, from 30.8–44.3% and 45.2–57.9% in 2019, respectively (Figure b). However, this increase in the proportion of patients with ASCVD was also observed among the total population of patients with T2D without new GLP-1 RA use (Figure b). Conclusion New use of GLP-1 RAs in patients with T2D increased in absolute terms between 2014 and 2019. Interestingly, the proportion of patients with ASCVD among those newly initiating the class has not changed relative to non-GLP-1 RA users over time, highlighting a gap in adoption of CVOT data in clinical practice by all specialities and the potential opportunity to further reduce CV risk in these patients. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Novo Nordisk