Prescribing Patterns of SGLT2 Inhibitors and GLP-1 Receptor Agonists in Patients With Type 2 Diabetes at Cardiology, Endocrinology, and Primary Care Visits

Abstract

Objective: To determine the prescribing rates of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) at cardiology, endocrinology, and primary care visits in a community health system.

Patients and methods: A cross-sectional study using electronic health record data from Bon Secours Mercy Health outpatient clinics across Virginia (2019, 2020, 2021) included patients 18 years and older with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or chronic kidney disease (CKD), and one or more outpatient visits. Adults with type 1 diabetes, stage 4/5 CKD, end-stage kidney disease, dialysis treatment, pregnancy, or hospice or palliative care were excluded. Prescribing rates were compared overall and for each subgroup among cardiology, endocrinology, and primary care visits using generalized linear mixed modeling with a random practice-level effect.

Results: The 22,060 included patients had a mean age of 68 years, 50% were female (n=11,030), 41.3% were Black race (n=9,100), and 74.8% were Medicare beneficiaries (n=16,498). In addition, 17,724 patients (80.3%) had ASCVD, 5276 (23.9%) CKD, and 5,965 (27.0%) HF. Overall, prescriptions for either drug class occurred in 17.4% of eligible patients (n=3,849). Cardiology visits had the lowest prescribing rates overall and for each diagnosis subgroup compared with endocrinology and primary care visits in the raw, unadjusted, and adjusted models.

Conclusion: Overall prescribing rates for SGLT2i and GLP-1 RA were low among adults with type 2 diabetes and ASCVD, HF, or CKD. Additional research is warranted to identify barriers, and potential solutions, to improve prescribing of these therapies.