Type 2 diabetes mellitus (T2DM) is associated with $37.3 billion in cardiovascular disease (CVD)-related costs.
1 Patients with T2DM have twice the risk of CVD morbidity and mortality than those without
T2DM, and more than 70% of T2DM patients will die of CVD.
Discussion of CVD benefits for second-line diabetes medi-
cations began appearing in clinical guidelines in early 2016.3
By 2019, findings were codified into treatment pathways for
people with T2DM and CVD.
4 Current guidelines recommend
that T2DM patients with established CVD who are unable
to maintain glycemic control on metformin should be prescribed a GPL1-RA or SGLT2i, with proven CVD benefit.
Analytics conducted an analysis to examine the use of GLP- 1
RA and SGLT2i (at the class level) in the treatment of patients
with T2DM and CVD, including trends over time and variation
across healthcare organizations (HCOs).
Overall, 110,000 patients, across 15 HCOs, aged 18–75
with > 2 ambulatory visits in primary care, endocrinology,
cardiology, or nephrology in the past 18 months and a diagnosis of T2DM and CVD were included in the analysis. The
prevalence of CVD in this T2DM population was 31%. During
the 36-month periods ending (March 31) Q1 2016, Q1 2017,
and Q1 2018, we looked at the rates of patients with a prescription for a GLP- 1 RA, SGLT2i, or, for comparison, DPP-4i,
overall and within each individual HCO.
Given the current guidelines for patients with T2DM and CVD,
prescription rates for a GLP- 1 RA or SGLT2i are low, especially
compared to DPP4i, although increasing over time.
The proportion of patients with T2DM and CVD with a
prescription for a GLP- 1 RA increased from 8.5% in 2016 Q1
to 11.6% in 2018 Q1. Similarly, the proportion with a SGLT2i
increased from 7.3% to 11.3%, while DPP-4i rates were
higher but stayed stable, increasing only slightly from 19.5%
Trends in Prescription Rates of Select Antidiabetic Medication
Classes — Overall and Across HCOs
Setting the Standard
Prescribing trends in patients with type 2 diabetes and