Few adults with type 2 diabetes use SGLT2 inhibitors, GLP-1 receptor agonists
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Fewer than one in 10 adults with type 2 diabetes in the U.S. use SGLT2 inhibitors or GLP-1 receptor agonists, and only SGLT2 inhibitors have seen an increase in use over the last decade, according to study findings.
“Kidney disease and cardiovascular disease are common in type 2 diabetes, and are associated with high morbidity and mortality,” Christine P. Limonte, MD, instructor and research fellow in the division of nephrology, department of medicine at the University of Washington, told Healio. “Both SGLT2 inhibitors and GLP-1 receptor agonists reduce the risk of kidney disease progression and cardiovascular events in people with type 2 diabetes by about 20% to 30%. Low use of SGLT2 inhibitors and GLP-1 receptor agonists, especially among patients at higher risk of kidney disease and CVD, means there are patients who may be missing out on the benefits that these agents may confer. Furthermore, low use of these agents in racial and ethnic minority groups and in people without health insurance may perpetuate health disparities in type 2 diabetes.”
Limonte and colleagues analyzed data from the National Health and Nutrition Examination Survey from 2017 through March 2020. All participants aged 20 years and older with type 2 diabetes and an estimated glomerular filtration rate of 30 mL/min/1.73 m2 or higher were included. Medications used were classified as SGLT2 inhibitors, GLP-1 receptor agonists, DPP-IV inhibitors, biguanides, insulin, sulfonylureas or thiazolidinediones. Demographics and history of coronary heart failure or atherosclerotic CVD were self-reported through a questionnaire. The findings were published in The Journal of Diabetes and Its Complications.
Use of SGLT2, GLP-1 agents low
SGLT2 inhibitors were used by 5.8% of adults with type 2 diabetes from 2017 to 2020. The percentage of adults aged 40 to 59 years using SGLT2 inhibitors was higher than in those younger than 40 years or older than 59 years (8% vs. 0.8% vs. 5%, respectively; P = .006). SGLT2 inhibitor use was higher among those who had a single health care provider compared with those who did not have a provider (8.2% vs. 2.1%; P = .007). Non-Hispanic Black adults and Mexican American adults were less likely to use SGLT2 inhibitors compared with non-Hispanic white adults (3.1% vs. 1.3% vs. 10.6%, respectively; P = .03).
GLP-1 receptor agonists were used by 4.4% of adults with type 2 diabetes from 2017 to 2020. Similar to SGLT2 inhibitor use rates, adults aged 40 to 59 years had a higher proportion using GLP-1 receptor agonists compared with younger adults and older adults (7% vs. 0.7% vs. 3.1%, respectively; P = .0001). GLP-1 receptor agonist use was lowest among Mexican American adults (2.4%), and uninsured adults were less likely to use the agents compared with adults with insurance (1.3% vs. 4.8%; P = .04). Adults with a BMI between 25 kg/m2 and 29.9 kg/m2 (2.9%) and those with a BMI of 30 kg/m2 or higher (5.7%) were more likely to use GLP-1 receptor agonists than with a BMI lower than 25 kg/m2 (0.2%; P = .002). Adults with a single health care provider were more likely to use a GLP-1 receptor agonists compared with those who did not have a single health care provider (6.6% vs. 1%; P = .002).
Use of other glucose-lowering medications higher
From 2017 to 2020, the proportion of adults using biguanides (63%), sulfonylureas (22.3%), insulin (19.1%) and DPP-IV inhibitors (11.2%) was higher than the percentage using SGLT2 inhibitors and GLP-1 receptor agonists. Among all glucose-lowering medications, only SGLT2 inhibitor use increased from 2013-2014 to 2017-2020 (P for trend < .0001).
Limonte said several steps can be taken to increase the usage of SGLT2 inhibitors and GLP-1 receptor agonists.
“Reducing drug costs and improving access to health care is essential to enhancing use of SGLT2 inhibitors and GLP-1 receptor agonists — high costs has been reported as a substantial limitation in several studies,” Limonte said. “Additionally, growing familiarity with these agents by medical providers is key for their increased prescription. Lastly, most GLP-1 receptor agonists are currently only available as injectables, and this mode of administration may be challenging for patients.”
For more information:
Christine P. Limonte, MD, can be reached at climonte@uw.edu.
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