Baseline characteristics and clinical outcomes of patients with type 2 diabetes and cardiovascular disease treated with GLP-1 receptor agonists and SGLT2 inhibitors

Abstract Background Patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) are at an exceptionally high risk of cardiovascular mortality. Treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2-I) and glucagon-like peptide-1 receptor agonists (GLP-1RA) has been shown to significantly reduce mortality in these patients. However, these medications remain underutilized in routine clinical practice. This study aimed to investigate the prescription patterns of SGLT2-I and GLP-1RA in diabetic patients with ASCVD. Methods The CARdiovascular and DIAbetes (CARDIA) cohort utilized the electronic health record database of Clalit Health Services (CHS). The study included patients with T2DM and ASCVD, divided into four groups based on their treatment regimen: (i) patients receiving both GLP-1RA and SGLT2-I; (ii) patients receiving SGLT2-I only; (iii) patients receiving GLP-1RA only; and (iv) patients not treated with either medication. Demographics, clinical characteristics, and laboratory data of the four groups were compared to identify predictors of prescription. Results The study cohort comprised 165,730 patients. Among them, 48% were not treated with either GLP-1RA or SGLT2-I, 23% received both medications, 7% were treated with GLP-1RA only, and 21% were treated with SGLT2-I only. Predictors of lower prescription rates for GLP-1RA and SGLT2-I included female gender, older age, non-coronary ASCVD, morbid obesity, and lack of follow-up in specialized cardiology or diabetes clinics. Conclusion This large, real-world cohort demonstrates that SGLT2-I and GLP-1RA prescription rates remain suboptimal in diabetic patients with ASCVD. Identifying predictors of low prescription rates highlights critical gaps in care. Efforts to improve adherence to guideline-recommended therapies are essential to optimizing clinical outcomes in this high-risk population.