Study calls for better use of life-saving therapies

In a recent study published in the American Journal of the Heartresearchers explore the effectiveness of current approaches to reduce the risk of cardiovascular events in patients with type 2 diabetes (DT2).

Study: Contemporary Use of Cardiovascular Risk Reduction Strategies in Type 2 Diabetes. Insights from the Diabetes Collaborative Registry. Image Credit: siam.pukkato / Shutterstock.com

T2D and cardiovascular health

Patients with T2D are at increased risk of hospitalization, decreased quality of life and financial costs due to cardiovascular complications. These complications are responsible for more than 50% of deaths in patients with T2D, and their incidence continues to increase.

Glucagon-like peptide-1 receptor (GLP-1RA) agonists and sodium-glucose cotransporter-2 (SGLT2i) inhibitors, both developed to lower glucose levels, have been shown to improve kidney health and cardiovascular disease, as well as mortality rates, in high-risk T2DM patients.

About the study

In the present study, the researchers analyze the trend in the use of evidence-based therapies to reduce cardiovascular risk in patients with T2D over time.

The study involved adult patients aged 18 years and older with T2D who were prescribed at least one hypoglycemic treatment from a list of drug classes, including insulin, sulfonylurea, metformin, thiazolidinedione (TZD), GLP1RA, DPP-4i and SGLT2i.

The study focused on several patient subgroups, including those with heart failure (HF), atherosclerotic cardiovascular disease (ASCVD), and chronic kidney disease (CKD). Within the ASCVD subgroup, patients suffered from a variety of conditions, such as peripheral arterial disease, coronary artery disease (CAD), and cerebrovascular disease. The cerebrovascular disease subgroup included patients with transient ischemic attack, prior stroke, and carotid artery surgery.

The researchers calculated a Diabetes Cardiovascular Composite Score (DCCS) to determine the effectiveness of cardiovascular risk reduction techniques for individual patients. This score indicated the percentage of drugs recommended to the patient for an optimal reduction of cardiovascular risk.

Five potential drugs were evaluated for a patient’s eligibility, including GLP-1RA, SGLT2i, statin, antithrombotic therapy, as well as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARA) and the angiotensin receptor neprilysin (ARNI) inhibitor.

Results

A total of 1,001,542 patients from 391 sites were included in the current study. The cohort had an average age of approximately 66 years and included 512,807 men.

More than 627,146 patients had at least one high-risk condition, including documented ASCV, heart failure or CKD. Specifically, 518,270 patients had reported ASCVD, 177,518 had noted a diagnosis of IC, and 230,519 had CKD. In addition, the average systolic blood pressure was almost 130 mmHg, while the average body mass index (BMI) was around 33 kg/m2 and the average hemoglobin A1C (HbA1C) was 7.4%. .

Metformin was the most commonly prescribed hypoglycemic drug, with a usage rate of 73.1%. Insulin was used by 36.6% of patients, while 12.5% ​​used SGLT2i and 12.9% used GLP-1RA.

The use of SGLT2i or GLP-1RA in patients increased from 4.1% to 28.8% from 2013 to 2019. However, DCCS decreased from 72% to 52% from 2013 to 2019 due to the increase in eligible drug options in the DCCS.

About 18% of 627,146 patients diagnosed with ASCVD, HF, or CKD received SGLT2i or GLP-1RA drugs. Younger male patients without reported IC, ASCVD, or CKD who were prescribed insulin were more frequently prescribed SGLT2i drugs. GLP-1RA drugs were frequently prescribed to younger patients, women, those without documented ASCVD or HF, and those taking insulin.

Male gender and an ASCVD diagnosis were associated with a greater likelihood of using GLP-1RA or SGLT2i. Comparatively, people older or with a diagnosis of IC or CKD were less likely to be prescribed these drugs.

Older patients, men, those with certain medical conditions such as ASCVD, CKD or HF, and those on insulin had higher DCCS. The hierarchical linear model revealed that male sex and a diagnosis of CRF were associated with higher DCCS, whereas an ASCVD or HF diagnosis was correlated with a lower DCCS.

conclusion

The results of the study revealed a positive trend in the use of hypoglycemic drugs in relation to a reduction in cardiovascular risk over time. However, despite the potential benefits, the use of these agents is suboptimal, particularly in patients with high-risk conditions.

The current study underscores the importance of educating cardiologists and patients about the additional benefits of therapies beyond lowering blood sugar. Educating health care providers about the benefits of the drugs SGLT2i and GLP-1RA, as well as providing guidance on prescribing these agents and adopting team-based models of care, can help change the perception of these drugs d hypoglycemic agents to instruments to reduce cardiovascular disease. risks in T2DM patients.