From the Departments of Family Medicine (AA, MK, DO, SJ, KB) and Public Health Sciences, (LEL) Henry Ford Hospital, Detroit, MI.
J Am Board Fam Med. 2022 Mar-Apr;35(2):255-264. doi: 10.3122/jabfm.2022.02.210360.
Glucagon-like peptide-1 agonists (GLP-1a) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are recommended in carefully selected patients with type 2 diabetes. This study will assess prescription of these medications and investigate predictors of prescription.
This retrospective cross-sectional study included 31,354 patients. Data including sociodemographic descriptors, clinical histories, medications, and health insurance providers were extracted from a health system's administrative databases. Variables to be associated with prescription of a GLP-1a or SGLT-2i were assessed using a multivariable logistic regression model.
Mean age was 62.58 years and 40.8% identified as African American. Only 3.4% were prescribed a GLP-1a and 2.1% received a SGLT-2i. Logistic regression demonstrated lower odds of receiving either medication in the highest age-group (70 to 79 years) (GLP-1a: odds ratio [OR] 0.44, < , SGLT-2i: OR 0.39, < ) and in African Americans (GLP-1a: OR 0.64, < , SGLT-2i: OR 0.28, < ). Atherosclerotic cardiovascular disease was not associated with GLP-1a prescription ( = ) and conferred lower odds of being prescribed SGLT-2i (OR 0.68, < ). History of chronic kidney disease conferred lower odds of receiving GLP-1a and was not associated with the odds of receiving SGLT-2i.
Prescription of GLP-1a and SGLT-2i medications was low as compared with existing literature. Advanced age and African American race were negatively associated with prescription of these medications. Contrary to guideline recommendations; atherosclerotic cardiovascular disease and chronic kidney disease were not positively associated with prescription.
胰高血糖素样肽-1 激动剂(GLP-1a)和钠-葡萄糖协同转运蛋白-2 抑制剂(SGLT-2i)被推荐用于精心挑选的 2 型糖尿病患者。本研究将评估这些药物的处方情况,并调查处方的预测因素。
本回顾性横断面研究纳入了 31354 名患者。数据包括社会人口统计学描述符、临床病史、药物和医疗保险提供者,从一个医疗系统的管理数据库中提取。使用多变量逻辑回归模型评估与 GLP-1a 或 SGLT-2i 处方相关的变量。
平均年龄为 62.58 岁,40.8%的患者为非裔美国人。仅 3.4%的患者被处方 GLP-1a,2.1%的患者接受 SGLT-2i 治疗。逻辑回归显示,在年龄最高的年龄组(70 至 79 岁)(GLP-1a:比值比[OR]0.44, < ,SGLT-2i:OR0.39, < )和非裔美国人(GLP-1a:OR0.64, < ,SGLT-2i:OR0.28, < )接受这两种药物的可能性较低。动脉粥样硬化性心血管疾病与 GLP-1a 处方无关( = ),但接受 SGLT-2i 处方的可能性较低(OR0.68, < )。慢性肾脏病病史降低了接受 GLP-1a 的可能性,与接受 SGLT-2i 的可能性无关。
与现有文献相比,GLP-1a 和 SGLT-2i 药物的处方率较低。年龄较大和非裔美国人种族与这些药物的处方呈负相关。与指南建议相反;动脉粥样硬化性心血管疾病和慢性肾脏病与处方无关。