@article{b1af96f31f584d948fe5e1084fb16033,
title = "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",
abstract = "OBJECTIVE There is mounting evidence regarding the cardiovascular benefits of sodium–glu-cose 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.",
author = "Dhruv Mahtta and Ramsey, {David J.} and Lee, {Michelle T.} and Liang Chen and Rifai, {Mahmoud Al} and Akeroyd, {Julia M.} and Vaughan, {Elizabeth M.} and Matheny, {Michael E.} and {Do Espirito Santo}, {Karla Rodrigues} and Navaneethan, {Sankar D.} and Lavie, {Carl J.} and Yochai Birnbaum and Ballantyne, {Christie M.} and Petersen, {Laura A.} and Virani, {Salim S.}",
note = "Funding Information: Funding. C.M.B. has received grant/research support from National Institutes of Health, American Heart Association, and American Diabetes Association. This work was supported by a Department of Veterans Affairs (VA) Health Services Research & Development Service Investigator Initiated Grants (IIR 16-072, IIR 19-069), the Houston VA Health Services Research & Development Center for Innovations grant (CIN13-413), and the National Institutes of Health/ National Institute of Diabetes and Digestive and Kidney Diseases (DK110341). Support for VA/ Centers for Medicare & Medicaid Services data was provided by the Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004). Duality of Interest. S.S.V. discloses honorarium from the American College of Cardiology (associate editor for Innovations, acc.org). C.J.L. has served as a consultant and promotional speaker for AstraZeneca of their SGLT2i. C.M.B. discloses grant/research support (all significant, paid to institution, not individual) from Akcea, Amgen, Esperion, Novartis, Regeneron, and Sanofi-Syn-thelabo, and as a consultant for Abbott Diagnostics, Akcea, Amarin, Amgen, Arrowhead, AstraZeneca, Corvidia, Denka Seiken, Esperion, Intercept, Matinas BioPharma, Merck, Novartis, Regeneron, and Sanofi-Synthelabo. Y.B. has received a research grant from AstraZeneca. S.N. has received honorarium from Bayer, Boehringer Ingelheim, Tricida, and Reata Pharmaceuticals. No other potential conflicts of interest relevant to this article were reported. Author Contributions. D.M. and S.S.V. contributed to conception, design, and interpretation of data, drafting and revising of the manuscript, and final approval of the manuscript submitted. D.J.R. and L.C. contributed to analysis and interpretation of data and final approval of the manuscript submitted. M.T.L., M.A.R., J.M.A., E.M.V., M.E.M., K.R.d.E.S., S.D.N., C.J.L., Y.B., C.M.B., and L.A.P. contributed to interpretation of data, revising of manuscript, and final approval of the manuscript. S.S.V. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: C.M.B. has received grant/research support from National Institutes of Health, American Heart Association, and American Diabetes Association. This work was supported by a Department of Veterans Affairs (VA) Health Services Research & Development Service Investigator Initiated Grants (IIR 16-072, IIR 19-069), the Houston VA Health Services Research & Development Center for Innovations grant (CIN13-413), and the National Institutes of Health/ National Institute of Diabetes and Digestive and Kidney Diseases (DK110341). Support for VA/ Centers for Medicare & Medicaid Services data was provided by the Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004). Publisher Copyright: {\textcopyright} 2022, American Diabetes Association Inc. All rights reserved.",
year = "2022",
month = feb,
doi = "10.2337/dc21-1815",
language = "English (US)",
volume = "45",
pages = "372--380",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "2",
}