Uptake of novel evidence-based therapies in patients with type 2 diabetes after a cardiovascular event: insights from CANHEART.

BACKGROUND

A cardiovascular (CV) hospitalization is a seminal opportunity to implement guideline-directed medical therapy (GDMT). Sodium-glucose transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1RAs) can improve outcomes among those with type 2 diabetes mellitus (T2DM) and CV disease.

METHODS

We conducted a population-based cohort study among patients aged ≥ 66 years with T2DM in Ontario hospitalized for a CV event (myocardial infarction, heart failure, peripheral arterial disease, ischemic stroke) from June 2015 to March 2022, who were followed until March 2023. We examined use of GDMT before vs after the index event, including use of SGLT2is, GLP1RAs, statins, and others medications.

RESULTS

We identified 75,869 people aged ≥ 66 years with T2DM (median age 78 years; 43% female). The proportion receiving SGLT2is was 9% before index hospitalization and 29% during the follow-up period. GLP1RA was used for 1% before vs 9% after, compared with 65% before and 86% after for statins. Use of novel GDMT increased across the follow-up period. The incidence of SGLT2i use 1-year posthospitalization was 4% in 2016 vs 39% in 2021; for GLP1RA use, the incidence was 0% in 2016 vs 11% in 2021.

CONCLUSIONS

A rise in the use of novel GDMT suggests increasing adoption of therapies to optimize secondary prevention in patients with T2DM and CV disease after index CV events.