Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor
agonists (GLP1-RAs) reduce cardiovascular events and mortality in patients with type
2 diabetes mellitus (T2DM). We sought to describe trends in prescribing for SGLT2is
and GLP1-RAs in diverse care settings, including (1) the outpatient clinics of a midwestern
integrated health system and (2) small- and medium-sized community-based primary care
practices and health centers in 3 midwestern states. We included adults with T2DM
and ≥1 outpatient clinic visit. The outcomes of interest were annual active prescription
rates for SGLT2is and GLP1-RAs (separately). In the integrated health system, 22,672
patients met the case definition of T2DM. From 2013 to 2019, the overall prescription
rate for SGLT2is increased from 1% to 15% (absolute difference [AD] 14%, 95% confidence
interval [CI] 13% to 15%, p <0.01). The GLP1-RA prescription rate was stable at 10%
(AD 0%, 95% CI −1% to 1%, p = 0.9). In community-based primary care practices, 43,340
patients met the case definition of T2DM. From 2013 to 2017, the SGLT2i prescription
rate increased from 3% to 7% (AD 4%, 95% CI 3% to 6%, p <0.01), whereas the GLP1-RA
prescription rate was stable at 2% to 3% (AD 1%, 95% CI −1 to 1%, p = 0.40). In a
fully adjusted regression model, non-Hispanic Black patients had lower odds of SGLT2i
or GLP1-RA prescription (odds ratio 0.56, 95% CI 0.34 to 0.89, p = 0.016). In conclusion,
the increase in prescription rates was greater for SGLT2is than for GLP1-RAs in patients
with T2DM in a large integrated medical center and community primary care practices.
Overall, prescription rates for eligible patients were low, and racial disparities
were observed.
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Article info
Publication history
Published online: November 21, 2022
Received in revised form:
October 10,
2022
Received:
April 26,
2022
Footnotes
Dr. Ahmad was supported by grants K12HS026385 from the Agency for Healthcare Research and Quality, Rockville, Maryland, K23HL155970 from the National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland, and1 856917 from the American Heart Association, Dallas, Texas,. Dr. Linder is supported by grant P30AG059988 from the National Institute on Aging, Bethesda, Maryland. This study was in part funded by grant 1R18HS023921 from the Agency for Healthcare Research and Quality, Rockville, Maryland.
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