Prescribing Patterns of SGLT2 Inhibitors and GLP-1 Receptor Agonists in Patients With T2DM and ASCVD in South Korea.

backgroundDespite the cardiovascular benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) in patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD), their utilization remains low globally. This study aimed to evaluate the utilization of SGLT2i and GLP1RA in patients with T2DM and ASCVD, as well as the factors associated with their use in South Korea.

methodsWe conducted a retrospective study using the National Patient Sample claims data from 2015 to 2020. Adults aged 20 years or older with confirmed diagnoses of both T2DM and ASCVD between March 1 and October 31 of each year were included. The utilization of SGLT2i and GLP1RA was assessed based on prescriptions filled within 60 days of the index date. Multivariable logistic regression was used to identify factors associated with their use. Annual trends in utilization were evaluated using the Cochran-Armitage trend test.

resultsIn our study of 57 576 study population, the use of SGLT2i increased from 1.20% in 2015 to 10.51% by 2020. GLP1RA usage increased from 0% to 1.17% over the same period. Older age, chronic kidney disease (OR 0.52, 95% CI 0.41-0.66), and concurrent use of dipeptidyl peptidase 4 inhibitors (DPP4i) (OR 0.09, 95% CI 0.09-0.10) significantly reduced the likelihood of SGLT2i use. In contrast, factors such as comorbid dyslipidemia (OR 1.41, 95% CI 1.25-1.60), heart failure (OR 1.22, 95% CI 1.09-1.37), concurrent use of sulfonylurea (SU) (OR 1.30, 95% CI 1.20-1.40), and prescriptions from cardiologists (OR 1.22, 95% CI 1.07-1.40) were positively associated with higher SGLT2i usage. For GLP1RA, negative influences included older age, concurrent DPP4i use (OR 0.12, 95% CI 0.08-0.16), and non-endocrinologist prescription, whereas female sex (OR 1.35, 95% CI 1.06-1.73), dyslipidemia (OR 1.68, 95% CI 1.10-2.66), and the use of insulin (OR 3.71, 95% CI 2.83-4.85), or SU (OR 3.13, 95% CI 2.44-4.02) use were positive factors.

conclusionsDespite the known cardiovascular benefits and increasing utilization trends of SGLT2i and GLP1RA, our findings reveal that 88.35% of eligible patients with T2DM and ASCVD remained untreated with these agents as of 2020. This study suggests disparities in the use of these agents based on patients' characteristics and physician specialties. Further efforts to explore and address potential barriers to the use of these agents could enhance their clinical benefits by improving access for high-risk patients.