Most adults with diabetes eligible for GLP-1 RAs, SGLT2 inhibitors, but few use them

Researchers estimated that more than 80% of adults with type 2 diabetes in the United States meet the criteria for GLP-1 receptor agonists or SGLT2 inhibitors, but only about one in 10 used either medication from 2017 to 2020.

“It’s important for primary care providers to be aware that many of their patients with type 2 diabetes may qualify for these medications,” Shichao Tang, PhD, of the CDC’s Division of Diabetes Translation, told Healio.

In 2022, the American Diabetes Association and European Association for the Study of Diabetes released a consensus report recommending the use of GLP-1 receptor agonists (RAs) or SGLT2 inhibitors among certain individuals with type 2 diabetes.

Specifically, the organizations recommended GLP-1 RAs for those who have or are at high risk for atherosclerotic CVD (ASCVD) and SGLT2 inhibitors for those who have established ASCVD, chronic kidney disease or heart failure or who are at high risk for ASCVD, according to Tang and colleagues.

The researchers conducted a study to estimate the percentage of U.S. adults who meet the recommended treatment criteria and used the medications. Their analysis included a nationally representative cohort of 1,330 nonpregnant adults aged 20 years or older who had type 2 diabetes and were enrolled in the National Health and Nutrition Examination Survey from 2017 to 2020 — a period when GLP-1 RAs and SGLT2 inhibitors were not recommended as first-line therapy, “though they were offered as second-line treatment,” Tang said.

Tang and colleagues defined patients at high risk for ASCVD as those aged 55 years or older who had at least two of the following conditions: albuminuria, dyslipidemia, hypertension, obesity and smoking.

Overall, the researchers estimated that, each year, 82.3% of U.S. adults with type 2 diabetes (n = 22.4 million) and most Medicare beneficiaries would meet the recommended criteria for GLP-1 RAs or SGLT2 inhibitors. Among those who met the criteria, 3.7% used GLP-1 RAs, 5.3% used SGLT2 inhibitors and 9.1% used either medication from 2017 to 2020.

Tang and colleagues noted that the study is limited due to the use of self-reported data that predate the most recent guidance on GLP-1 RAs and SGLT2 inhibitors. They also wrote that these medications may not be cost-effective as first-line treatment options among all eligible patients with type 2 diabetes.

“This study highlights areas where more research would be helpful. For example, more research is needed into the cost-effectiveness of these medications. More knowledge about cost-effectiveness may help target treatments for individuals at a sustainable cost,” Tang said. “It’s also important to continue research since the change in recommendations. Newer data, when available, may help us observe if and how the new recommendations affect usage of these therapeutics.”