Prescription patterns of CV and kidney protective therapies among patients with type 2 diabetes

Julio A. Lamprea-Montealegre

The cardiorenal protective effects of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) and glucagon‐like peptide 1 receptor agonists (GLP-1RA) are well established. The current American Diabetes Association (ADA) guidelines recommend SGLT2i or GLP-1RA irrespective of glycemic control among patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD) or high-risk ASCVD, heart failure, and chronic kidney disease (CKD). As per Julio A. Lamprea-Montealegre, “The ADA recommendations represent a paradigm shift in the prevention of the adverse cardiac and kidney consequences of diabetes”. Hence, a cross-sectional analysis was conducted to evaluate the contemporary prescription patterns of SGLT2i and GLP-1RA in patients with T2D.

Study Design and Patient Population

The study was conducted in the Veteran Affairs Healthcare System (VACHS), the largest integrated health care system in the US. The VACHS system provides uniform pharmacy benefits with discounted or free medications to its affiliates, so there was almost no influence of medication cost on the prescriptions.

The study included a cross-sectional analysis from 2019 to 2020 with the main outcome defined as any active prescription of an SGLT2i or a GLP-1RA during the study period. Patients with a diagnosis of T2D and at least one primary care clinic visit during the study period were included in the study. Of the total study population (1.3 million patients), 10% had a prescription for an SGLT2i and 7% for a GLP-1 RA.

Study Results

Prescription of SGLT2i and GLP-1RA was low among patients with T2D and concomitant ASCVD, heart failure, and CKD. For the three conditions, the prescription was lower than 15% irrespective of glycemic control.

Figure 1: Prescription of an SGLT2 inhibitor and GLP-1RA according to comorbid conditions.

The prescription of SGLT2i decreases with worsening kidney function, even in patients with CKD and eGFR between 30 to 60 in whom these medications have shown to have significant cardiac and kidney protective effects. Among patients with CKD, the presence of severe albuminuria was inversely associated with the prescription of SGLT2i and GLP-1 RA, independent of eGFR.

Prescription of SGLT2i and GLP1-RA among patients with CKD

Figure 2: The prescription of SGLT 2 inhibitors decreases with worsening kidney function.

Prescription of SGLT2i and GLP1-RA among patients with CKD

Figure 3: SGLT2i and GLP-1 RA prescription by albuminuria status.

Moreover, higher ASCVD risk and higher end-stage kidney disease (ESKD) risk were inversely associated with the prescription of these medications.

As per Lamprea-Montealegre, “This study would set a baseline that can guide subsequent improvement efforts for the improved prescription of these medications to the highest risk patients who would derive the largest benefit”.

Reference

Julio A. Lamprea-Montealegre. 178-OR: Prescription patterns of CV and kidney protective therapies among patients with type 2 diabetes. Oral presentation at: American Diabetes Association 82nd Scientific Sessions; June, 2022.