Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs
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Abstract
OBJECTIVE: There is mounting evidence regarding the cardiovascular benefits of sodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use. RESEARCH DESIGN AND METHODS: We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1 RA and the facility-level variation in their use. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1 RA in patients with ASCVD and T2DM. RESULTS: Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received an SGLT2i while 8.0% of patients received a GLP-1 RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10th–90th percentile) facility-level rates were 14.92% (9.31–22.50) for SGLT2i and 10.88% (4.44–17.07) for GLP-1 RA. There was significant facility-level variation among SGLT2i use—MRRunadjusted: 1.41 (95% CI 1.35–1.47) and MRRadjusted: 1.55 (95% CI 1.46 –1.63). Similar facility-level variation was observed for use of GLP-1 RA—MRRunadjusted: 1.34 (95% CI 1.29–1.38) and MRRadjusted: 1.78 (95% CI 1.65–1.90). CONCLUSIONS: Overall utilization rates of SGLT2i and GLP-1 RA among eligible patients are low, with significantly higher residual facility-level variation in the use of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients.
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Other studies have demonstrated low rates of SGLT2i and GLP1ra medication use (11.2% and 8%, respectively), even among patients at high risk of cardiovascular disease.
“Consistent with our findings, other studies have demonstrated low rates of SGLT2i and GLP1ra medication use (11.2% and 8%, respectively), even among patients at high risk of cardiovascular disease.12–16,32”
From Disparities in Use of Novel Diabetes Medications by Insurance: A Nationally Representative Cohort Study (2024) · cites this paper as [32]
Prior studies of racial and ethnic disparities in SGLT2i and GLP-1 RA use included few younger patients or women.
“or few younger patients or women,6,8,9”
From Race and ethnicity and pharmacy dispensing of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes (2024) · cites this paper as [9]
The study did not examine providers' prescribing patterns over time.
“First, we did not examine providers’ prescribing patterns over time; prior studies have found similar racial and ethnic disparities.8,9”
From Race and ethnicity and pharmacy dispensing of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes (2024) · cites this paper as [9]
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Incremental Prognostic Value of a Coronary Heart Disease Polygenic Risk Score in Type 2 Diabetes
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Effect of Dapagliflozin on Measured vs. Panel‐Estimated Glomerular Filtration Rate
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Variation in Low-Value Service Use Across Veterans Affairs Facilities
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Glucagon-Like Peptide 1 Receptor Agonists and the Deepening Health Equity Divide in America
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Access to GLP-1s: Where Do Employers Fit in?
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- Authors
- Mahtta, D., Ramsey, D. J., Lee, M. T., Chen, L., Al Rifai, M., Akeroyd, J. M., Vaughan, E. M., Matheny, M. E., Santo, K. R. D. E., Navaneethan, S. D., Lavie, C. J., Birnbaum, Y., Ballantyne, C. M., Petersen, L. A., & Virani, S. S.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
- Baylor College of Medicine (US)
- VA Tennessee Valley Healthcare System (US)
- Hospital Israelita Albert Einstein (BR)
- The University of Queensland (AU)
- Corresponding author
- Virani, Salim S.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2022-01-17
- Volume
- 45
- Issue
- 2
- Pages
- 372-380
- ISSN
- 0149-5992 (ISSN-L)
- PMC
- PMC8914426
- OpenAlex
- W4205761485
- Cited by
- 137
- References
- 36
- Citations by year
- 2026: 23 · 2025: 34 · 2024: 32 · 2023: 29 · 2022: 19
- FWCI
- 21.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Commons-TMC (Texas Medical Center) (submittedVersion)
- Funders
- American Diabetes Association
- U.S. Department of Veterans Affairs (IIR 16-072, SDR 02-237, IIR 19-069, CIN13-413, I01 HX003868)
- American Heart Association
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (DK110341, K23DK110341, R01DK129474)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- SGLT2 inhibitors, GLP-1 receptor agonists, atherosclerotic cardiovascular disease, type 2 diabetes, facility-level variation, Veterans Affairs health care, real-world prescribing patterns, racial and ethnic disparities, sex disparities, geographic disparities
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Veterans
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