Contemporary National Patterns of Eligibility and Use of Novel Cardioprotective Antihyperglycemic Agents in Type 2 Diabetes Mellitus.

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE
    • Publication Information:
      Original Publication: Oxford : Wiley-Blackwell
    • Subject Terms:
      Blood Glucose/*drug effects ; Cardiovascular Diseases/*prevention & control ; Diabetes Mellitus, Type 2/*drug therapy ; Eligibility Determination/*trends ; Glucagon-Like Peptide-1 Receptor/*agonists ; Incretins/*therapeutic use ; Practice Patterns, Physicians'/*trends ; Sodium-Glucose Transporter 2 Inhibitors/*therapeutic use; Aged ; Biomarkers/blood ; Blood Glucose/metabolism ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/epidemiology ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/diagnosis ; Diabetes Mellitus, Type 2/epidemiology ; Drug Utilization/trends ; Female ; Guideline Adherence/trends ; Heart Disease Risk Factors ; Humans ; Incretins/adverse effects ; Male ; Middle Aged ; Nutrition Surveys ; Practice Guidelines as Topic ; Risk Assessment ; Sodium-Glucose Transporter 2 Inhibitors/adverse effects ; Time Factors ; Treatment Outcome ; United States/epidemiology
    • Abstract:
      Background SGLT-2 (sodium glucose transporter-2) inhibitors and GLP-1RAs (glucagon-like peptide-1 receptor agonists) effectively lowered cardiovascular risk in large clinical trials for patients with type 2 diabetes mellitus at high risk for these complications, and have been recommended by guidelines. To evaluate the contemporary landscape in which these recommendations would be implemented, we examined the use of these medications according to clinical guideline practice. Methods and Results In the National Health and Nutrition Examination Survey for 2017 to 2018, we defined compelling indications for SGLT-2 inhibitors by the presence of atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, and for GLP-1RAs by the presence of established or high-risk atherosclerotic cardiovascular disease, based on large clinical trials that have been incorporated in guideline recommendations of the American College of Cardiology and American Diabetes Association. We then evaluated use of these medications among patients with physician-diagnosed type 2 diabetes mellitus. All analyses incorporated complex survey design to produce nationally representative estimates. A total 1104 of 9254 sampled individuals had type 2 diabetes mellitus, representing 10.6% (95% CI, 9.7%-11.6%) of the US population or 33.2 million adults nationally. Of these, 52.6% (95% CI, 47.7%-57.5%) had an indication for SGLT-2 inhibitors, 32.8% (95% CI, 28.8%-37.2%) for GLP-1RAs, and 26.6% (95% CI, 22.2%-31.7%) for both medications. During 2017 to 2018, 4.5% (95% CI, 2.4%-8.2%) were treated with SGLT-2 inhibitors and 1.5% (95% CI, 0.7%-3.2%) with GLP-1RAs. Atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease were not independently associated with SGLT-2 inhibitor or GLP-1RA use in patients with diabetes mellitus. Conclusions Despite a large number of patients being eligible for guideline-recommended cardiorenal protective therapies, there are substantial gaps in the use of SGLT-2 inhibitors and GLP-1RAs, limiting their public health benefits.
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    • Grant Information:
      K23 HL153775 United States HL NHLBI NIH HHS; UL1 TR001863 United States TR NCATS NIH HHS; P30 AG021342 United States AG NIA NIH HHS; K23 AG048359 United States AG NIA NIH HHS
    • Contributed Indexing:
      Keywords: GLP1‐RAs; cardioprotective medications; diabetes mellitus; novel agents; sodium glucose transporter‐2 inhibitors
    • Accession Number:
      0 (Biomarkers)
      0 (Blood Glucose)
      0 (GLP1R protein, human)
      0 (Glucagon-Like Peptide-1 Receptor)
      0 (Incretins)
      0 (Sodium-Glucose Transporter 2 Inhibitors)
    • Publication Date:
      Date Created: 20210517 Date Completed: 20211029 Latest Revision: 20220327
    • Publication Date:
      20231215
    • Accession Number:
      PMC8403287
    • Accession Number:
      10.1161/JAHA.121.021084
    • Accession Number:
      33998258