More than 80% of American adults with type 2 diabetes (T2D) meet criteria for treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or sodium-glucose cotransporter-2 inhibitors (SGLT2is), but few actually receive these medications, according to a research letter in the Annals of Internal Medicine.
The researchers analyzed data on 1330 adults with T2D from the National Health and Nutrition Examination Survey 2017–2020. Of these adults, 82.3% of patients met recommended criteria for GLP-1 RA or SGLT2i treatment. Criteria were met by all patients with established or high risk for atherosclerotic cardiovascular disease (ASCVD), heart failure, or chronic kidney disease (CKD). Ninety-seven percent of patients aged 65 years or older met treatment criteria, as did 70% of younger patients. Treatment criteria were met by 94.5% of Medicare patients.
Only 9.1% of patients were receiving either of these medications between 2017 and 2020, a time when they were not recommended for first-line treatment in many patients who would now be considered eligible. Treatment rates were 5.3% for SGLT2is and 3.7% for GLP-1 RAs.
Based on level A evidence, a 2022 consensus report by the American Diabetes Association and the European Association for the Study of Diabetes recommended GLP-1 RA treatment for patients with T2D with established or high risk for ASCVD. The report also recommended SGLT2is for patients with established ASCVD, CKD, or heart failure or high risk for ASCVD.
This study suggests that most US adults with T2D would meet those treatment criteria, including nearly all Medicare beneficiaries. During the period studied, only approximately 9% of eligible patients were receiving GLP-1 RAs or SGLT2is.
“However, at current drug pricing, using these two new medications as first-line agents among all eligible patients with T2D may not be cost-effective,” the researchers conclude. “[A]n assessment of cost-effectiveness may assist better targeting of interventions to achieve the greatest effect at a sustainable cost” [Tang S, et al. Recommended and prevalent use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors in a national population-based sample. Ann Intern Med, published online ahead of print February 28, 2023. doi: 10.7326/M22-3051; https://www.acpjournals.org/doi/10.7326/M22-3051].
