Why the study?
SGLT2i and GLP-1RA show benefits in diabetes with CVD, HF, and CKD, but prescribing rates in those with versus without cardiorenal indications needed evaluation.
Are SGLT2 inhibitors and GLP-1 receptor agonists appropriately prescribed to high-risk diabetes patients with cardiorenal indications in primary care?
Are SGLT2 inhibitors and GLP-1 receptor agonists appropriately prescribed to high-risk diabetes patients with cardiorenal indications in primary care?
Answers are grounded in this paper and cite their sources.
Despite guideline recommendations, SGLT2 inhibitors and GLP-1 receptor agonists are significantly underprescribed in primary care patients with diabetes and pre-existing cardiorenal disease compared to those without these high-risk conditions.
BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown benefits in patients with diabetes and cardiovascular disease (CVD), heart failure (HF), and chronic kidney disease (CKD). OBJECTIVE: We assessed benchmark outcomes (Hemoglobin A1c, LDL-C, and blood pressure), identified the prevalence of cardiorenal indications for SGLT2i and GLP-1RA, and compared prescribing rates of GLP1-RA and SGLT2i in those with and without cardiorenal indications. METHODS: We analyzed data from January 2018-June 2019 for 7168 patients with diabetes using electronic medical records from the Northern Alberta Primary Care Research Network, a regional network of the Canadian Primary Sentinel Surveillance Network (CPCSSN). Patients with and without cardiorenal comorbidities were compared using descriptive statistics and two proportion Z tests. RESULTS: Hemoglobin A1c ≤ 7.0% was met by 56.8%, blood pressure < 130/80 mmHg by 62.1%, LDL-C ≤ 2.0 mmol/L by 45.3% of patients. There were 4377 patients on glucose lowering medications; metformin was most common (77.7%), followed by insulin (24.6%), insulin secretagogues (23.6%), SGLT2i (19.7%), dipeptidyl peptidase-4 inhibitor (19.3%), and GLP-1RA (9.4%). A quarter of patients had cardiorenal indications for SGLT2i or GLP-1RA. Use of SGLT2i in these patients was lower than in patients without cardiorenal comorbidities (14.9% vs 21.2%, p < 0.05). GLP-1RA use in these patients was 4.6% compared with 11% in those without cardiorenal comorbidities (p < 0.05). DISCUSSION: Contrary to current evidence and recommendations, SGLT2i and GLP1-RA were less likely to be prescribed to patients with pre-existing CVD, HF, and/or CKD, revealing opportunities to improve prescribing for patients with diabetes at high-risk for worsening cardiorenal complications.
No takes yet. Share an insight, caveat, or question.
Hao et al. (2022) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: