2819-LB: Adoption of GLP-1RA and SGLT2i Drug Classes among Patients with Cardiovascular or Renal Indications: Evolution of Prescribing Patterns over Time

Introduction and Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose transporter 2 inhibitors (SGLT2i) are crucial components of type 2 diabetes care, especially for adults with cardiovascular disease (CVD) or diabetic kidney disease (DKD). However, early adoption of GLP-1RA and SGLT2i remains low. Our aim was to evaluate the association between prescription of GLP-1RA and SGLT2i medications and presence of indications for the drugs among patients with type 2 diabetes and how prescribing patters have evolved between 2016 and 2023. Methods: We analyzed EHR data from adults with type 2 diabetes with one or more indications for GLP-1RA or SGLT2i - 1) CVD or DKD, 2) obesity, or 3) high HbA1c (above 8%) within a large regional health system. We used cluster-robust linear probability modeling with a primary outcome of receiving a GLP-1RA or SGLT2i prescription and predictor of indication for GLP-1RA or SGLT2i therapy. To examine changes over time, we introduced an interaction term of time period, 2016-2018, 2019-2021, and 2022-2023. Results: We analyzed data from 7,917 adults and 12,667 patient-time-periods. CVD or DKD increased probability of prescription of either drug by 6.4%, obesity by 12.6%, and high A1c by 16.3% (p0.001 for all). CVD or DKD was not associated with acceleration in prescribing rate over time, while obesity significantly accelerated prescribing in the third time period by 7% (p=0.01 for interaction). For the 2022-2023 period, estimated prescription rates were similar for obesity (50.9%) and high A1c (50.7%) but lower for CVD or DKD (46.7%). Conclusion: Adults with type 2 diabetes and CVD or DKD had increased prescribing of GLP-1RA and SGLT2i, continue to receive the GLP-1RA and SGLT2i at lower rates than adults with obesity or high A1c. Targeted clinical interventions, such as clinical decision support tools, are needed to ensure that guideline-based prescribing increases to maximize population benefit in high-risk patients with type 2 diabetes. Disclosure H.A. Torres: None. T. Moin: None. N. Jackson: None. Y. Tsugawa: None. C. Mangione: None. Funding UCLA STAR Program