Contemporary utilization of GLP1 receptor agonists and SGLT2 inhibitors in patients with diagnosed type 2 diabetes and cardiovascular disease in the United States

Over the past decades, cardiovascular outcome trials of glucagon-like peptide-1 receptor agonists (GLPR1RA) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) have shown significant cardiovascular risk reduction in patients with type 2 diabetes (T2D) and cardiovascular disease (CVD).1,2 As a result, guidelines recommend initiation of these medications as first line therapy in eligible patients.3,4 These medications, however, remain underutilized in clinical care owing to therapeutic inertia, cost, patient hesitancy among others. GLP1RA (Semaglutide, Liraglutide, Dulaglutide) and SGLT2i (Dapagliflozin, Empagliflozin, Canagliflozin, Ertugliflozin) overall, by sex/race groups (white male, white female, African American male, African American female, Hispanic, Asian), insurance type, and whether patients had visits with cardiologists or endocrinologists at any time. Many opportunities exist to improve utilization of these medications,8 including broader insurance coverage and updating the insurance-level appropriateness criteria to mirror those of societal clinical practice guidelines.