Ondergebruik van SGLT2-remmers en GLP-1-agonisten bij T2D met ASCVD — real-world analyse

AIMS/HYPOTHESIS: To evaluate prescription patterns of sodium-glucose cotransporter 2, inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) among, patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (ASCVD) within a contemporary healthcare system. METHODS: We conducted a retrospective analysis of the Houston Methodist Cardiovascular Learning Health System Registry, encompassing electronic medical records from June 2016 to August 2023. Adults with T2D and comorbid ASCVD were identified using validated algorithms based on ICD-10 codes, laboratory values, and medication records. Prescription rates of SGLT2i and GLP-1RAs were assessed, and multivariable logistic regression analyses were performed to identify factors associated with their use. RESULTS: Among 791,873 adults seen in outpatient settings, 8096 met criteria for T2D with comorbid ASCVD. The mean age was 69.4 ± 9.7 years; 38.8% were women, and 56.1% were non-Hispanic White. Overall, 22% received SGLT2i prescriptions, and 25.3% received GLP-1RAs prescriptions. Patients prescribed SGLT2i were younger, more likely male, privately insured, and had higher HbA1c levels, as well as higher prevalence of chronic kidney disease (CKD) and heart failure (HF). GLP-1RAs recipients were younger, more often female, non-Hispanic White, privately insured, and had higher body mass index (BMI). In logistic regression analysis, men were more likely to be prescribed SGLT2i after adjusting for age, comorbidities and socioeconomic parameters for secondary prevention of ASCVD as a whole and across subtypes of ASCVD. Women were more likely to be prescribed GLP-1RAs after adjusting for age, comorbidities, obesity and socioeconomic parameters for secondary prevention of ASCVD, CAD and PAD but not significant in stroke. CONCLUSIONS/INTERPRETATION: Despite guideline recommendations, prescription rates of SGLT2i and GLP-1RAs remain low in high-risk patients with T2D and ASCVD across CVD subtypes. Notable disparities exist based on gender, race, and socioeconomic status, underscoring the need for targeted interventions to address these gaps in care.