Use of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagonlike Peptide-1 Receptor Agonists in Patients With Diabetes and Cardiovascular Disease in Community Practice.
JAMA Cardiol
; 8(1): 89-95, 2023 01 01.
Article
en En
| MEDLINE
| ID: mdl-36322056
ABSTRACT
Importance Recent national guidelines recommend sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD); yet, there are limited data on the use of these agents in contemporary community practice. Objective:
To evaluate the use of SGLT2i and GLP-1 RA in adults with T2D and ASCVD across a diverse sample of health care systems in the US. Design, Setting, andParticipants:
This multicenter, retrospective cohort study used electronic health record data from 88 US health care systems participating in Cerner Real World Data between January 2018 to March 2021. Adults with ASCVD and T2D taking at least 1 glucose-lowering medication, had end-stage kidney disease, or had stage 5 chronic kidney disease were excluded. Main Outcomes andMeasures:
Treatment with SGLT2i or GLP-1 RA.Results:
A total of 321â¯304 patients were identified with T2D and ASCVD ASCVD (130 280 female [40.5%]; median [IQR] age, 70.9 [62.9-78.0] years) who were potentially eligible for SGLT2i and/or GLP-1 RA, including 37â¯754 Black individuals (11.8%), 51â¯522 Hispanic individuals (16.0%), and 256â¯008 White individuals (11.8%). From January 2018 to March 2021, the use of SGLT2i increased from 5.8% (11â¯285 of 194â¯264) to 12.9% (11â¯058 of 85â¯956), GLP-1 RA increased from 6.9% (13â¯402 of 194â¯264) to 13.8% (11â¯901 of 85â¯956), and use of either agent increased from 11.4% (22â¯069 of 194â¯264) to 23.2% (19â¯909 of 85â¯956). Those taking an SGLT2i or GLP-1 RA were younger, less frequently hospitalized in the year prior, and more likely to be taking additional secondary prevention medications. Treated and nontreated populations were similar in terms of race, ethnicity, and outpatient health care utilization. Sulfonylureas and dipeptidyl peptidase 4 inhibitors remained more commonly used than SGLT2i or GLP-1 RA through 2021. Conclusions and Relevance In this study, uptake of SGLT2i and GLP-1 RA in adults with T2D and ASCVD increased modestly after guideline recommendations, although less than a quarter of persons with ASCVD and T2D receiving medical therapy were taking either. Further efforts are necessary to maximize the potential population benefit of these therapies in this high-risk population.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Enfermedades Cardiovasculares
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Diabetes Mellitus Tipo 2
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Inhibidores del Cotransportador de Sodio-Glucosa 2
Tipo de estudio:
Clinical_trials
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Guideline
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Observational_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
Idioma:
En
Revista:
JAMA Cardiol
Año:
2023
Tipo del documento:
Article