Are we there yet? Increasing use of cardioprotective antihyperglycemic agents in patients with T2D and CVD or CV risk in the United States

Abstract

Objective

To report on the use of antihyperglycemic agents (AHAs) by age (i.e. <65, ≥65 years) in patients with type 2 diabetes (T2D) and cardiovascular disease (CVD) or cardiovascular risk (CV risk) factors in the United States.

Methods

Patients with T2D and CVD (CVD cohort) or T2D and an additional CV risk factor without pre-existing CVD (CV risk cohort) were identified from 2015 to 2019 in a claims database. Patients were followed from their first observed CVD diagnosis or CV risk factor for each year they were continuously enrolled or until occurrence of a CVD diagnosis (CV risk cohort only). Classes of AHAs received were reported by year, cohort, and age group.

Results

From 2015 to 2019, the percentage of patients <65 years on glucagon-like peptide-1 receptor agonists (GLP-1 RAs) increased (CVD: 9–17%, CV risk: 9–17%) and was approximately twice that of those ≥65 years (CVD: 4–8%, CV risk: 4–8%); the percentage of patients <65 years on sodium-glucose cotransporter-2 (SGLT2) inhibitors increased (CVD: 11–16%, CV risk: 11–17%) and was approximately triple that of those ≥65 years (CVD: 3–6%, CV risk: 4–7%).

Conclusions

The use of GLP-1 RAs and SGLT2 inhibitors increased during the study period; however, most patients did not receive these medications. Patients aged ≥65 years were particularly disadvantaged.

Keywords:

• Type 2 diabetes
• antihyperglycemic treatment
• treatment patterns
• glucagon-like peptide-1 receptor agonists
• sodium-glucose cotransporter-2 inhibitors
• cardiovascular disease
• cardiovascular risk

Transparency

Declaration of funding

Financial support for the conduct of the research and preparation of the article were provided by Eli Lilly and Company. Employees of Eli Lilly and Company participated in the study design, interpretation of study data, in the writing of the report, and in the decision to submit the article for publication.

Declaration of financial/other relationships

R. Mody, M. Yu, and J. Levine are employees of Eli Lilly and Company. J. Meyers and K. Davis are employees of RTI Health Solutions. RTI Health Solutions received funding from Eli Lilly and Company to conduct this study. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

R. Mody was involved in the conceptualization, methodology, funding acquisition, supervision, and review and editing of the written manuscript; J. Meyers was involved in the methodology, formal analysis, and writing the original draft of the manuscript; M. Yu was involved in the conceptualization, methodology, and review and editing of the written manuscript; K. Davis was involved in the validation, methodology, supervision, and review and editing of the written manuscript; and J. Levine was involved in the conceptualization, methodology, and review and editing of the written manuscript.

Acknowledgements

The study coauthors would like to thank Brian Calingaert for his assistance with the analysis of the study data.

Data availability statement

This study used deidentified data from the IBM Watson Health Analytics’ MarketScan (MarketScan) Commercial Claims and Encounters (CCAE) and the Medicare Supplemental databases. These data are available for purchase from IBM Watson.