Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX.
Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX.
Diabetes Care. 2022 Feb 1;45(2):372-380. doi: 10.2337/dc21-1815.
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.
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.
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).
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.
在患有动脉粥样硬化性心血管疾病 (ASCVD) 和 2 型糖尿病 (T2DM) 的患者中，钠-葡萄糖共转运蛋白 2 抑制剂 (SGLT2i) 和胰高血糖素样肽 1 受体激动剂 (GLP-1 RA) 的心血管获益证据越来越多。关于这些药物类别的真实世界实践模式的数据很少。我们旨在评估这些药物类别的使用率和其使用在机构层面的差异。
我们使用了 2020 年 1 月 1 日至 2020 年 12 月 31 日全国退伍军人事务部 (VA) 医疗保健系统数据集，纳入了患有明确 ASCVD 和 T2DM 的患者。在这些患者中，我们评估了 SGLT2i 和 GLP-1 RA 的使用情况及其在机构层面的使用差异。机构层面的差异使用中位数比率 (MRR) 进行计算，这是衡量两个随机机构在患有 ASCVD 和 T2DM 的患者中使用 SGLT2i 和 GLP-1 RA 的可能性的指标。
在 130 个 VA 机构的 537980 名患有 ASCVD 和 T2DM 的患者中，11.2%的患者接受了 SGLT2i，8.0%的患者接受了 GLP-1 RA。接受这些心脏保护降糖药物类别的患者平均年龄较小，且非西班牙裔白人的比例较高。总体而言，SGLT2i 的机构层面中位 (10 至 90 百分位数) 使用率为 14.92%（9.31-22.50），GLP-1 RA 的使用率为 10.88%（4.44-17.07）。SGLT2i 的使用存在显著的机构层面差异-MRRunadjusted：1.41（95%CI 1.35-1.47）和 MRRadjusted：1.55（95%CI 1.46-1.63）。GLP-1 RA 使用率也存在类似的机构层面差异-MRRunadjusted：1.34（95%CI 1.29-1.38）和 MRRadjusted：1.78（95%CI 1.65-1.90）。
在符合条件的患者中，SGLT2i 和 GLP-1 RA 的总体使用率较低，这些药物类别的使用在机构层面上仍存在显著差异。我们的结果表明，有机会优化这些药物的使用，以预防这些患者未来发生不良心血管事件。
