Current guidelines for the management of type 2 diabetes mellitus (T2DM) strongly recommend the use of glucagon like peptide-1 receptor agonists (GLP-1RAs) in patients with T2DM and established cardiovascular disease (CVD), to attenuate cardiovascular risk. Nevertheless, it appears that implementation of guidelines in real-world conditions remains suboptimal. The intention of this study is to evaluate the frequency of GLP-1RA use among individuals with T2DM and established CVD in a real-world setting and to compare patient profiles between GLP-1RAs users and non-users. A retrospective analysis was conducted using medical records of patients with T2DM and established CVD that were hospitalized in one internal medicine clinic and one cardiology clinic of a tertiary hospital in Athens, Greece. Demographic and laboratory parameters, comorbidity profile and medication use were recorded and compared between the GLP-1RA and non-GLP-1RA groups. The analysis included 202 patients with T2DM and established CVD, of whom the 49 (24.3%) were receiving a GLP-1RA. The patients in the GLP-1RA group were younger, had higher creatinine, urea, hemoglobin and hematocrit values than the participants not treated with GLP-1RAs. Dyslipidemia was found to be more prevalent among GLP-1RA users, whereas hypertension appeared less frequently. Heart failure rates were higher in the GLP-1RA group and the difference was almost statistically significant. Differences between the groups regarding other comorbidities were not able to reach statistical significance. There was marked higher use of insulin and sodium–glucose co-transporter-2 inhibitors in the group of patients using GLP-1RAs. In contrast, there was a statistically notable lower use of metformin among GLP-1RA users and no statistically meaningful difference in the use of renin-angiotensin-aldosterone system inhibitors between the two groups was observed. This retrospective observational study demonstrates a discrepancy between guideline recommendations and real-world practice in the use of GLP-1RAs among patients with T2DM and established CVD. Prescription decisions appear to remain primarily driven by glycemic control, reflecting persistent clinical inertia patterns despite robust data on the cardiovascular benefits of these agents. Targeted strategies to improve guideline implementation are needed to optimize care and outcomes in this high-risk population. The findings should be interpreted with caution given the retrospective observational design and the limited availability of glycated hemoglobin, anthropometry and diabetes duration data.
Γεώργιος Η. Βουρνάς (Thu,) studied this question.