Use of Lipid-, Blood Pressure–, and Glucose-Lowering Pharmacotherapy in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease
Open accessAbstract
Importance: Based on contemporary estimates in the US, evidence-based therapies for cardiovascular risk reduction are generally underused among patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). Objective: To determine the use of evidence-based cardiovascular preventive therapies in a broad US population with diabetes and ASCVD. Design, Setting, and Participants: This multicenter cohort study used health system-level aggregated data within the National Patient-Centered Clinical Research Network, including 12 health systems. Participants included patients with diabetes and established ASCVD (ie, coronary artery disease, cerebrovascular disease, and peripheral artery disease) between January 1 and December 31, 2018. Data were analyzed from September 2020 until January 2021. Exposures: One or more health care encounters in 2018. Main Outcomes and Measures: Patient characteristics by prescription of any of the following key evidence-based therapies: high-intensity statin, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) and sodium glucose cotransporter-2 inhibitors (SGLT2I) or glucagon-like peptide-1 receptor agonist (GLP-1RA). Results: The overall cohort included 324 706 patients, with a mean (SD) age of 68.1 (12.2) years and 144 169 (44.4%) women and 180 537 (55.6%) men. A total of 59 124 patients (18.2% ) were Black, and 41 470 patients (12.8%) were Latinx. Among 205 885 patients with specialized visit data from the prior year, 17 971 patients (8.7%) visited an endocrinologist, 54 330 patients (26.4%) visited a cardiologist, and 154 078 patients (74.8%) visited a primary care physician. Overall, 190 277 patients (58.6%) were prescribed a statin, but only 88 426 patients (26.8%) were prescribed a high-intensity statin; 147 762 patients (45.5%) were prescribed an ACEI or ARB, 12 724 patients (3.9%) were prescribed a GLP-1RA, and 8989 patients (2.8%) were prescribed an SGLT2I. Overall, 14 918 patients (4.6%) were prescribed all 3 classes of therapies, and 138 173 patients (42.6%) were prescribed none. Patients who were prescribed a high-intensity statin were more likely to be men (59.9% [95% CI, 59.6%-60.3%] of patients vs 55.6% [95% CI, 55.4%-55.8%] of patients), have coronary atherosclerotic disease (79.9% [95% CI, 79.7%-80.2%] of patients vs 73.0% [95% CI, 72.8%-73.3%] of patients) and more likely to have seen a cardiologist (40.0% [95% CI, 39.6%-40.4%] of patients vs 26.4% [95% CI, 26.2%-26.6%] of patients). Conclusions and Relevance: In this large cohort of US patients with diabetes and ASCVD, fewer than 1 in 20 patients were prescribed all 3 evidence-based therapies, defined as a high-intensity statin, either an ACEI or ARB, and either an SGLT2I and/or a GLP-1RA. These findings suggest that multifaceted interventions are needed to overcome barriers to the implementation of evidence-based therapies and facilitate their optimal use.
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Cardiovascular risk factors are predicted to increase and only a minority of people with type 2 diabetes achieve recommended risk factor goals and are treated with guideline-recommended therapy.
“Despite these encouraging opportunities to reduce morbidity and mortality, cardiovascular risk factors are predicted to increase and only a minority of people with type 2 diabetes achieve recommended risk factor goals and are treated with guideline-recommended therapy (7)(8)(9).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [9]
The Discussion and Conclusions report that fewer than 1 in 20 US patients with type 2 diabetes and ASCVD received all three evidence-based therapies, supporting the claim about limited use of recommended treatment in that population. The paper does not report that cardiovascular risk factors are predicted to increase or establish how many patients achieve recommended risk-factor goals; its cohort also does not represent all people with type 2 diabetes. No page numbers are available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOnly a minority of people with type 2 diabetes achieve recommended risk factor goals and are treated with guideline-recommended therapy.
“only a minority of people with type 2 diabetes achieve recommended risk factor goals and are treated with guideline-recommended therapy (7–9).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [9]
The Conclusions report that fewer than 1 in 20 patients received all three evidence-based cardiovascular risk–mitigating therapies, supporting the treatment portion of the claim. The study concerns patients with both type 2 diabetes and ASCVD, not all people with type 2 diabetes. Its Results list risk-factor measurements but do not report the proportion achieving recommended risk-factor goals. (LLM, conf=0.86)
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CVOT Summit 2022 Report: new cardiovascular, kidney, and glycemic outcomes
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How Can We Increase the Utilization of Evidence-Based Medication After Myocardial Infarction?
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Cardiometabolic Health: Actionable Prevention Strategies and New Care Models
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Type 2 Diabetes Mellitus: Molecular Pathogenesis and Therapeutic Interventions
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- Authors
- Nelson, A. J., O’Brien, E. C., Kaltenbach, L. A., Green, J. B., Lopes, R. D., Morse, C. G., Al-Khalidi, H. R., Aroda, V. R., Cavender, M. A., Gaynor, T., Kirk, J. K., Lingvay, I., Magwire, M. L., McGuire, D. K., Pak, J., Pop-Busui, R., Richardson, C. R., Senyucel, C., Kelsey, M. D., Pagidipati, N. J., & Granger, C. B.
- Affiliations
- Duke University (US)
- Duke Clinical Research Institute, Durham, North Carolina
- Wake Forest University Health Sciences (US)
- Brigham and Women's Hospital (US)
- University of North Carolina at Chapel Hill (US)
- Boehringer Ingelheim (United States) (US)
- The University of Texas Southwestern Medical Center (US)
- Saint Luke's Health System (US)
- Parkland Health & Hospital System (US)
- University of Michigan, Ann Arbor
- University of Michigan (US)
- Eli Lilly and Company, Indianapolis, Indiana
- Corresponding author
- Granger, Christopher B.
- ORCID
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2022-02-17
- Volume
- 5
- Issue
- 2
- Pages
- e2148030
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC8855234
- OpenAlex
- W4212978690
- Cited by
- 78
- References
- 53
- Citations by year
- 2026: 13 · 2025: 20 · 2024: 18 · 2023: 20 · 2022: 7
- FWCI
- 12.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- JAMA Network Open (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Amgen
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Patient-Centered Outcomes Research Institute
- Edwards Lifesciences
- CSL Behring
- Regeneron Pharmaceuticals
- Intarcia Therapeutics
- MannKind Corporation
- Mylan
- Verily Life Sciences
- Diabetes Australia
- Royal Australasian College of Physicians
- Eisai
- Novo Nordisk
- Esperion Therapeutics
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926, P30DK020572)
- Duke Clinical Research Institute
- Daiichi Sankyo Europe
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- type 2 diabetes, atherosclerotic cardiovascular disease, high-intensity statins, ACE inhibitors, angiotensin receptor blockers, SGLT2 inhibitors, GLP-1 receptor agonists, lipid-lowering therapy, blood pressure-lowering therapy, glucose-lowering therapy, treatment underuse, health care utilization, primary care
- MeSH terms
- Aged, Aged, 80 and over, Antihypertensive Agents, Hypolipidemic Agents, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Male, Middle Aged, United States, Cohort Studies, Atherosclerosis
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