2015 - 2020年美国国家健康与营养检查调查：按心血管 - 肾脏疾病风险分层的糖尿病成年患者中胰高血糖素样肽 - 1受体激动剂和钠 - 葡萄糖协同转运蛋白2抑制剂的使用情况
Glucagon-like peptide-1 receptor agonist and sodium-glucose cotransporter 2 inhibitor use among adults with diabetes mellitus by cardiovascular-kidney disease risk: National Health and Nutrition Examination Surveys, 2015-2020.
作者信息
Jacobs Joshua A, Zheutlin Alexander R, Derington Catherine G, King Jordan B, Pandey Ambarish, Bress Adam P
机构信息
Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States.
Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
出版信息
Am J Prev Cardiol. 2023 Nov 27;17:100624. doi: 10.1016/j.ajpc.2023.100624. eCollection 2024 Mar.
OBJECTIVE
Glucagon-like peptide-1 receptor agonists (GLP1-RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2Is) lower adverse cardiac and kidney events among high-risk patients with diabetes mellitus (DM) and are now guideline-recommended as first-line therapy alongside metformin. However, the adoption of these new treatments from 2015 to 2020 among the highest-risk adults with DM remains unclear.
METHODS
We performed a cross-sectional analysis of the National Health and Nutrition Examination Surveys (NHANES) 2015-2020 to estimate the use of GLP1-RAs and SGLT2Is among adults with DM overall and by level of cardiovascular and kidney risk (CKR). We defined high CKR by history of atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), heart failure, or age ≥55 years with at least 2 ASCVD risk factors (i.e., obesity, hypertension, hyperlipidemia, or current smoker).
RESULTS
Overall, 2,432 participants with DM (mean age 60.6 years, 46.8 % female, 58.8 % Non-Hispanic White) were included, of which 1,869 and 563 were with and without high CKR, respectively. Participants with vs. without high CKR were more likely to be older, have higher systolic blood pressure, lower estimated glomerular filtration rate, use oral antidiabetic agents, and have health insurance. Overall, the weighted prevalence of GLP1-RA or SGLT2I was 9.0 % (95 % confidence interval [CI] 6.9-11.0): 4.8 % (95 % CI 3.6-6.1) took GLP1-RAs, and 5.1 % (95 % CI 3.3-7.0) took SGLT2Is. Use of GLP1-RAs or SGLT2Is did not differ between participants with vs. without high CKR (adjusted prevalence ratio [aPR] 1.00; 95 % CI 0.98-1.02). Participants with ASCVD were more likely to be on a GLP1-RA or SGLT2I (aPR 1.28; 95 % CI 1.25-1.31), while adults with CKD were less likely (aPR 0.84; 95 % CI 0.82-0.86).
CONCLUSION
Among US adults with DM, GLP1-RA and SGLT2I use was low regardless of CKR. Data since 2020 analyzing the utilization of GLP1-RAs and SGLT2Is among high-CKR patients with DM is needed to identify implementation strategies for increased utilization.
目的
胰高血糖素样肽-1受体激动剂（GLP1-RAs）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2Is）可降低糖尿病（DM）高危患者的不良心脏和肾脏事件风险，目前已被指南推荐为与二甲双胍并列的一线治疗药物。然而，2015年至2020年期间，这些新疗法在DM高危成年患者中的采用情况仍不明确。
方法
我们对2015 - 2020年国家健康与营养检查调查（NHANES）进行了横断面分析，以估计GLP1-RAs和SGLT2Is在总体DM成年患者中的使用情况，以及按心血管和肾脏风险（CKR）水平的使用情况。我们根据动脉粥样硬化性心血管疾病（ASCVD）病史、慢性肾脏病（CKD）、心力衰竭，或年龄≥55岁且至少有2个ASCVD风险因素（即肥胖、高血压、高脂血症或当前吸烟者）来定义高CKR。
结果
总体纳入了2432例DM患者（平均年龄60.6岁，46.8%为女性，58.8%为非西班牙裔白人），其中1869例有高CKR，563例无高CKR。有高CKR的参与者比无高CKR的参与者更可能年龄较大、收缩压较高、估计肾小球滤过率较低、使用口服降糖药且有医疗保险。总体而言，GLP1-RA或SGLT2I的加权患病率为9.0%（95%置信区间[CI] 6.9 - 11.0）：4.8%（95% CI 3.6 - 6.1）使用GLP1-RAs，5.1%（95% CI 3.3 - 7.0）使用SGLT2Is。有高CKR与无高CKR的参与者之间GLP1-RAs或SGLT2Is的使用情况无差异（调整患病率比[aPR] 1.00；95% CI 0.98 - 1.02）。患有ASCVD的参与者更可能使用GLP1-RA或SGLT2I（aPR 1.28；95% CI 1.25 - 1.31），而患有CKD的成年人则可能性较小（aPR 0.84；95% CI 0.82 - 0.86）。
结论
在美国DM成年患者中，无论CKR如何，GLP1-RA和SGLT2I的使用都较低。需要2020年以来分析DM高CKR患者中GLP1-RAs和SGLT2Is使用情况的数据，以确定提高使用率的实施策略。
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