What question did this study set out to answer?

To evaluate real-world prescription trends and guideline adherence for SGLT2 inhibitors and GLP-1 receptor agonists, and to identify factors associated with undertreatment in individuals with type 2 diabetes and cardiorenal disease.

January 10, 2026Frontiers in EndocrinologyOpen Access

Implementation of guideline-recommended organ-protective therapy in people with type 2 diabetes and cardiovascular disease, heart failure, or kidney disease: real-world evidence from a German University Hospital

Q: What are the key findings of this study?

Guideline adherent therapy with SGLT2i and GLP1RA increased from 10.2% to 48.7% in people with type 2 diabetes and cardiorenal comorbidities, highlighting ongoing treatment gaps.

Q: What does this research mean for the field?

Guideline adherent therapy with SGLT2i and GLP1RA increased from 10.2% to 48.7% in people with type 2 diabetes and cardiorenal comorbidities, highlighting ongoing treatment gaps. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

SGLT2i and GLP1RA uptake in cardiorenal T2D increases to ~49%, highlighting ongoing treatment gaps.

Why the study?

Organ-protective therapy with SGLT2i and GLP1RA is recommended for people with type 2 diabetes and cardiorenal comorbidities, but real-world uptake remains uncertain.

Does the real-world implementation of guideline-recommended SGLT2i and GLP1RA therapy in patients with type 2 diabetes and cardiorenal comorbidities increase over time, and what factors are associated with undertreatment?

Key Points

To evaluate real-world prescription trends and guideline adherence for SGLT2 inhibitors and GLP-1 receptor agonists, and to identify factors associated with undertreatment in individuals with type 2 diabetes and cardiorenal disease.
Analyzed electronic health record data from the University Hospital Essen FHIR clinical data lake spanning 2019 to 2024.
Identified 19,684 adults with type 2 diabetes and cardiorenal comorbidities (ASCVD/high risk, heart failure, chronic kidney disease) qualifying for organ-protective therapy using ICD-10, German surgery procedure codes, and clinical data.
Assessed prescription patterns of SGLT2 inhibitors and GLP-1 receptor agonists via Anatomical Therapeutic Chemical medication codes, using chi-square tests and multivariable logistic regression modeling.
Guideline-adherent therapy increased from 10.2% to 48.7% between 2019 and 2024, with overall SGLT2 inhibitor use at 44.7%, GLP-1 receptor agonist use at 9.5%, and combination therapy at 5.5%.
Treatment rates differed across comorbidities, ranging from 32.5% in individuals with chronic kidney disease to 63.9% in those with all three cardiorenal comorbidities.
Guideline adherence was significantly lower in women (OR 0.76, 95% CI 0.66-0.89, p<0.001) and older individuals (OR 0.98, 95% CI 0.99-0.97, p<0.0001), but higher with more comorbidities (OR 1.26, 95% CI 1.18-1.34, p<0.0001) and medications (OR 1.98, 95% CI 1.88-2.08, p<0.0001).

Structured PICO

Population

19,684 adults with type 2 diabetes and cardiorenal comorbidities (atherosclerotic cardiovascular disease/high ASCVD risk, heart failure, or chronic kidney disease), mean age 70.3, 36.8% female, from a German University Hospital (2019-2024).

Intervention

Guideline-recommended organ-protective therapy with sodium-glucose cotransporter 2 inhibitors (SGLT2i) and/or glucagon-like peptide-1 receptor agonists (GLP1RA).

Comparator

No treatment with SGLT2i and/or GLP1RA.

Outcome

Guideline adherence and treatment trends (uptake rates) of SGLT2i and GLP1RA over the observation period (2019-2024).

Real-world uptake of guideline-recommended SGLT2i and GLP1RA therapy in patients with type 2 diabetes and cardiorenal comorbidities has increased significantly but remains underutilized, particularly among women and older patients.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Persistent gaps in women and older adults warrant clinical vigilance; leaves open optimal implementation strategies.

Cite This Study

Suliman et al. (2026) studied this question. Guideline adherent therapy with SGLT2i and GLP1RA increased from 10.2% to 48.7% in people with type 2 diabetes and cardiorenal comorbidities, highlighting ongoing treatment gaps.

synapsesocial.com/papers/696321d091e05aa366cb810f https://doi.org/10.3389/fendo.2025.1736984

Topics

HFrEF treatment Heart failure SGLT2 inhibitors in heart failure

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Implementation of guideline-recommended organ-protective therapy in people with type 2 diabetes and cardiovascular disease, heart failure, or kidney disease: real-world evidence from a German University Hospital

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Implementation of guideline-recommended organ-protective therapy in people with type 2 diabetes and cardiovascular disease, heart failure, or kidney disease: real-world evidence from a German University Hospital

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider