medwireNews: Findings from the DISCOVER study indicate that global use of sodium-glucose cotransporter (SGLT)2 inhibitors and glucagon-like peptide (GLP)-1 receptor agonists has increased over time among people with type 2 diabetes, but remains suboptimal.
The study included data from 14,576 individuals across 37 countries who were enrolled between September 2014 and June 2016. At baseline, 10.8% started treatment on either an SGLT2 inhibitor (8.7%), a GLP-1 receptor agonist (2.1%), or a combination of both (0.1%) as second-line therapy.
After 3 years of follow-up, the number of people on at least one of these medications increased to 16.8% (14.4% on SGLT2 inhibitors and 3.2% on GLP-1 receptor agonists). Despite this increase, the use of these “glucose-lowering medications with cardiovascular benefits remains suboptimal,” said presenter Suzanne Arnold (Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA) at the virtual ADA 81st Scientific Sessions.
Patient characteristics such as younger age, male sex, and higher BMI were associated with significantly higher rates of SGLT2 inhibitor or GLP-1 receptor agonist use, with odds ratios (ORs) of 0.77 (per 10 years), 1.17, and 1.51 (per 5 kg/m2), respectively. Individuals who had coronary artery disease were also more likely to receive either medication (OR=1.29) than those without, while peripheral artery disease (OR=0.73) and chronic kidney disease (OR=0.73) comorbidities were associated with lower rates of use.
Arnold said that people treated by cardiologists were more likely to be on a SGLT2 inhibitor than those treated by primary care physicians and other specialists, and therefore she suggested that “targeted education for [primary care physicians] may be most beneficial” to increase awareness of the potential benefit of these medications beyond glucose control.
The presenter reported large country-level variability in the use of these medications, which was “independent of patient factors including comorbidities.” She highlighted that a “deeper understanding of how to overcome structural barriers that limit more widespread use of these medications across countries, especially in high-risk patients,” was needed.
Arnold closed her presentation by emphasizing the need for “greater targeting of medications to patients with established cardiovascular disease as these are the highest-risk patients [who stand to gain] the greatest amount of benefit.”
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