Real-World Treatment Patterns of Glucose-Lowering Agents Among Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease or At Risk for Cardiovascular Disease: An Observational, Cross-Sectional, Retrospective Study

Abstract

Introduction: There is limited published literature on longitudinal utilization of glucose-lowering agents (GLAs) among patients with type 2 diabetes (T2D) and cardiovascular disease (CVD or risk of CVD). This retrospective, observational study aimed to provide updated evidence on patient characteristics and utilization of GLAs among patients with T2D and CVD or risk of CVD in the United States.

Methods: This was a cross-sectional evaluation of patients with T2D aged 50-89 years with annual continuous enrolment in a Medicare Advantage and Prescription Drug plan, identified from administrative claims data (Humana Research Database). Patients with T2D and atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF) (CVD cohort), or T2D and an additional CVD risk factor without pre-existing CVD (CVD risk cohort) were identified from 2015 to 2019. Patients were followed from their first observed ASCVD/HF diagnosis or CVD risk factor for each year they were continuously enrolled or until occurrence of a CVD diagnosis (CVD risk cohort only). Use of GLA classes were reported by year, cohort, and age groups (50-64 years and ≥ 65 years).

Results: The percentage of patients on sodium-glucose co-transporter-2 inhibitors (SGLT-2is), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and GLP-1 RAs with proven cardiovascular benefit, respectively, increased from 2015 to 2019 among ≥ 65 years (CVD cohort: 1.1-3.4%, 1.6-4.0%, and 1.2-3.8%; CVD risk cohort: 1.4-3.7%, 2.0-4.3%, and 1.5-4.1%); and among 50-64 years (CVD cohort: 2.6-7.3%, 4.3-10.1%, and 3.4-9.4%; CVD risk cohort: 3.3-6.8%, 4.6-9.6%, and 3.5-8.9%).

Conclusions: Although use of SGLT-2is and GLP-1 RAs increased over time, overall utilization of these agents in patients with T2D and ASCVD/HF or at risk for ASCVD/HF remained low, especially for those aged ≥ 65 years.

Keywords: Cardiovascular disease; Glucagon-like peptide-1 receptor agonists; Sodium-glucose co-transporter-2 inhibitors; Treatment patterns; Type 2 diabetes.

Fig. 1

Study design and patient attrition. The figure represents the patient attrition for each year. The dotted line represents patients excluded as per the criteria each year. Patients with ASCVD/HF were included in the CVD cohort and patients at risk for ASCVD/HF were included in the CVD risk cohort. ^** “prior” evaluation only applies to 2016 onwards. To identify patients with T2D in 2015, we only looked at 2015 claims. ASCVD atherosclerotic cardiovascular disease, CKD chronic kidney disease, CVD cardiovascular disease, ESRD end-stage renal disease, HF heart failure, MAPD Medicare Advantage and Prescription Drug, T1D type 1 diabetes mellitus, T2D type 2 diabetes

Fig. 2

Glucose-lowering agent use in patients aged ≥ 65 and 50–64 years with T2D and ASCVD/heart failure (CVD cohort). A, B Usage of glucose-lowering agents in patients aged ≥ 65 years and 50–64 years, respectively. Cardioprotective GLP-1 RA includes liraglutide, injectable semaglutide, or dulaglutide. Others include amylin agonists, meglitinides, and alpha-glucosidase inhibitors. Fixed-dose combinations including insulin degludec-liraglutide (subcutaneous) and insulin glargine-lixisenatide (subcutaneous) were not shown since usage was < 0.5%. ASCVD atherosclerotic cardiovascular disease, CDPT GLP-1RAs cardioprotective glucagon-like peptide-1 receptor agonists, CVD cardiovascular disease, DPP-4is dipeptidyl peptidase-4 inhibitors, GLP-1 RAs glucagon-like peptide-1 receptor agonists, SGLT-2is sodium-glucose Co-transporter-2 inhibitors, TZD thiazolidinediones

Fig. 3

Glucose-lowering agent use in patients aged ≥ 65 and 50–64 years with T2D and risk factors for ASCVD/heart failure (CVD risk cohort). A, B Usage of glucose-lowering agents in patients aged ≥ 65 years and 50–64 years, respectively. Cardioprotective GLP-1 RA includes liraglutide, injectable semaglutide, or dulaglutide. Others include amylin agonists, meglitinides, and alpha-glucosidase inhibitors. Fixed-dose combinations including insulin degludec-liraglutide (subcutaneous) and insulin glargine-lixisenatide (subcutaneous) were not shown since usage was < 0.4%. ASCVD atherosclerotic cardiovascular disease, CDPT GLP-1RAs cardioprotective glucagon-like peptide-1 receptor agonists, CVD cardiovascular disease, DPP-4is dipeptidyl peptidase-4 inhibitors, GLP-1 RAs glucagon-like peptide-1 receptor agonists, SGLT-2is sodium-glucose Co-transporter-2 inhibitors, TZD thiazolidinediones