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Observational Study
. 2024 Oct 4;12(5):e004431.
doi: 10.1136/bmjdrc-2024-004431.

Recent trends in GLP-1 RA and SGLT2i use among people with type 2 diabetes and atherosclerotic cardiovascular disease in the USA

Aaron King  1 , Xi Tan  2 , Neil Dhopeshwarkar  3 , Rhonda Bohn  4 , Katherine Dea  5 , Charles E Leonard  6 , Adam de Havenon  7
Affiliations
Observational Study

Recent trends in GLP-1 RA and SGLT2i use among people with type 2 diabetes and atherosclerotic cardiovascular disease in the USA

Aaron King et al. BMJ Open Diabetes Res Care. .

Abstract

Introduction: This study aimed to assess recent trends in the US use of glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i) in people with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD), including incident use following newly diagnosed ASCVD.

Research design and methods: This real-world, retrospective observational study used de-identified data from the TriNetX Dataworks-USA network. A longitudinal analysis of cross-sectional data (interval: January 01, 2018 to December 31, 2022) assessed the yearly prevalent use of GLP-1 RA and SGLT2i. A nested cohort study (January 01, 2017 to January 31, 2023) assessed the proportions of patients with T2D newly prescribed GLP-1 RAs and SGLT2is after incident ASCVD diagnosis.

Results: Prevalent use of GLP-1 RA and/or SGLT2i increased from 9.2% of patients in 2018 to 27.1% in 2022, with eligible annual patient numbers ranging from 279,474 to 348,997. GLP-1 RA-alone use rose from 5.2% to 9.9% and SGLT2i-alone use rose from 2.8% to 12.2% over this interval. Incident use of GLP-1 RA and/or SGLT2i within the year following ASCVD diagnosis increased from 5.9% to 17.0% (2018-2022). For GLP-1 RA alone, this increase was from 3.6% to 7.8%, while for SGLT2i alone, it was from 1.8% to 7.0%.

Conclusions: Use of GLP-1 RAs/SGLT2is in patients with T2D and ASCVD has increased in recent years in the USA, but remains suboptimal given the prevalence of ASCVD and its high morbidity and mortality.

Keywords: Diabetes Mellitus, Type 2; Glucagon-Like Peptide 1.

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Conflict of interest statement

Competing interests: AK: Paid speaker and clinical advisor for Astellas Pharma, Abbott, Dexcom, Eli Lilly, MannKind and Novo Nordisk. XT: Employee of Novo Nordisk. ND: Employee of TriNetX LLC. RB: No conflicts of interest. KD: Consultant of TriNetX LLC. CEL: CEL reports NIH funding. CEL is a special government employee of the US Food and Drug Administration. CEL recently received honoraria from the American College of Clinical Pharmacy Foundation and the Consortium for Medical Marijuana Clinical Outcomes Research. CEL consults for Novo Nordisk and TriNetX, LLC. CEL’s spouse is employed by Merck; neither she nor he own stock in the company. AdH: AdH reports NIH funding, consultant fees from Novo Nordisk, royalty fees from UpToDate, and has equity in Titin KM and Certus.

Figures

Figure 1
Figure 1. (A) Schematic of the cross-sectional study, estimating the proportion of patients with T2D and ASCVD who were prescribed GLP-1 RAs or SGLT2is. (B) Schematic of the nested cohort study, assessing the proportion of patients with T2D who were newly prescribed GLP-1 RAs or SGLT2is after an ASCVD diagnosis. ASCVD, atherosclerotic cardiovascular disease; GLP-1 RA, glucagon-like peptide-1 receptor agonist; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T2D, type 2 diabetes.
Figure 2
Figure 2. Cross-sectional study outcomes. Proportion of patients with T2D and ASCVD who were prescribed GLP-1 RAs or SGLT2is by year. ASCVD, atherosclerotic cardiovascular disease; GLP-1 RA, glucagon-like peptide-1 receptor agonist; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T2D, type 2 diabetes.
Figure 3
Figure 3. Nested cohort outcomes. Proportion of patients with T2D and newly diagnosed ASCVD who were newly prescribed GLP-1 RAs or SGLT2is, overall and by year. ASCVD, atherosclerotic cardiovascular disease; GLP-1 RA, glucagon-like peptide-1 receptor agonist; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T2D, type 2 diabetes.
See this image and copyright information in PMC

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