Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVER
Abstract Background Despite strong evidence of benefit, uptake of newer glucose-lowering medications that reduce cardiovascular risk has been low. We sought to examine global trends and predictors of use of SGLT2i and GLP-1 RA in patients with type 2 diabetes. Methods DISCOVER is a global, prospecti...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | BMC Endocrine Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12902-022-01026-2 |
| _version_ | 1818012961873068032 |
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| author | Suzanne V. Arnold Fengming Tang Andrew Cooper Hungta Chen Marilia B. Gomes Wolfgang Rathmann Iichiro Shimomura Jiten Vora Hirotaka Watada Kamlesh Khunti Mikhail Kosiborod |
| author_facet | Suzanne V. Arnold Fengming Tang Andrew Cooper Hungta Chen Marilia B. Gomes Wolfgang Rathmann Iichiro Shimomura Jiten Vora Hirotaka Watada Kamlesh Khunti Mikhail Kosiborod |
| author_sort | Suzanne V. Arnold |
| collection | DOAJ |
| description | Abstract Background Despite strong evidence of benefit, uptake of newer glucose-lowering medications that reduce cardiovascular risk has been low. We sought to examine global trends and predictors of use of SGLT2i and GLP-1 RA in patients with type 2 diabetes. Methods DISCOVER is a global, prospective, observational study of patients with diabetes enrolled from 2014–16 at initiation of second-line glucose-lowering therapy and followed for 3 years. We used hierarchical logistic regression to examine factors associated with use of either an SGLT2i or GLP-1 RA at last follow-up and to assess country-level variability. Results Among 14,576 patients from 37 countries, 1579 (10.8%) were started on an SGLT2i (1275; 8.7%) or GLP-1 RA (318; 2.2%) at enrollment, increasing to 16.1% at end of follow-up, with large variability across countries (range 0–62.7%). Use was highest in patients treated by cardiologists (26.1%) versus primary care physicians (10.4%), endocrinologists (16.9%), and other specialists (22.0%; p < 0.001). Coronary artery disease (OR 1.29, 95% CI 1.08–1.54) was associated with greater use of SGLT2i or GLP-1 RA while peripheral artery disease (OR 0.73, 95% CI 0.54–1.00) and chronic kidney disease (OR 0.73, 95% CI 0.58–0.94) were associated with lower use (OR 0.73, 95% CI 0.54–1.00). The country-level median odds ratio was 3.48, indicating a very large amount of variability in the use of SGLT2i or GLP-1 RA independent of patient demographic and clinical factors. Conclusions Global use of glucose-lowering medications with established cardiovascular benefits has increased over time but remains suboptimal, particularly in sub-groups most likely to benefit. Substantial country-level variability exists independent of patient factors, suggesting structural barriers may limit more widespread use of these medications. |
| first_indexed | 2024-04-14T06:26:31Z |
| format | Article |
| id | doaj.art-ec3b44102c7e4396b62acc311ae65d72 |
| institution | Directory Open Access Journal |
| issn | 1472-6823 |
| language | English |
| last_indexed | 2024-04-14T06:26:31Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Endocrine Disorders |
| spelling | doaj.art-ec3b44102c7e4396b62acc311ae65d722022-12-22T02:07:47ZengBMCBMC Endocrine Disorders1472-68232022-04-012211710.1186/s12902-022-01026-2Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVERSuzanne V. Arnold0Fengming Tang1Andrew Cooper2Hungta Chen3Marilia B. Gomes4Wolfgang Rathmann5Iichiro Shimomura6Jiten Vora7Hirotaka Watada8Kamlesh Khunti9Mikhail Kosiborod10Saint Luke’s Mid America Heart InstituteSaint Luke’s Mid America Heart InstituteAstraZenecaAstraZenecaRio de Janeiro State UniversityInstitute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine UniversityGraduate School of Medicine, Osaka UniversityUniversity of LiverpoolJuntendo UniversityUniversity of LeicesterSaint Luke’s Mid America Heart InstituteAbstract Background Despite strong evidence of benefit, uptake of newer glucose-lowering medications that reduce cardiovascular risk has been low. We sought to examine global trends and predictors of use of SGLT2i and GLP-1 RA in patients with type 2 diabetes. Methods DISCOVER is a global, prospective, observational study of patients with diabetes enrolled from 2014–16 at initiation of second-line glucose-lowering therapy and followed for 3 years. We used hierarchical logistic regression to examine factors associated with use of either an SGLT2i or GLP-1 RA at last follow-up and to assess country-level variability. Results Among 14,576 patients from 37 countries, 1579 (10.8%) were started on an SGLT2i (1275; 8.7%) or GLP-1 RA (318; 2.2%) at enrollment, increasing to 16.1% at end of follow-up, with large variability across countries (range 0–62.7%). Use was highest in patients treated by cardiologists (26.1%) versus primary care physicians (10.4%), endocrinologists (16.9%), and other specialists (22.0%; p < 0.001). Coronary artery disease (OR 1.29, 95% CI 1.08–1.54) was associated with greater use of SGLT2i or GLP-1 RA while peripheral artery disease (OR 0.73, 95% CI 0.54–1.00) and chronic kidney disease (OR 0.73, 95% CI 0.58–0.94) were associated with lower use (OR 0.73, 95% CI 0.54–1.00). The country-level median odds ratio was 3.48, indicating a very large amount of variability in the use of SGLT2i or GLP-1 RA independent of patient demographic and clinical factors. Conclusions Global use of glucose-lowering medications with established cardiovascular benefits has increased over time but remains suboptimal, particularly in sub-groups most likely to benefit. Substantial country-level variability exists independent of patient factors, suggesting structural barriers may limit more widespread use of these medications.https://doi.org/10.1186/s12902-022-01026-2DiabetesCardiovascular diseaseQuality of care |
| spellingShingle | Suzanne V. Arnold Fengming Tang Andrew Cooper Hungta Chen Marilia B. Gomes Wolfgang Rathmann Iichiro Shimomura Jiten Vora Hirotaka Watada Kamlesh Khunti Mikhail Kosiborod Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVER BMC Endocrine Disorders Diabetes Cardiovascular disease Quality of care |
| title | Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVER |
| title_full | Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVER |
| title_fullStr | Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVER |
| title_full_unstemmed | Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVER |
| title_short | Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVER |
| title_sort | global use of sglt2 inhibitors and glp 1 receptor agonists in type 2 diabetes results from discover |
| topic | Diabetes Cardiovascular disease Quality of care |
| url | https://doi.org/10.1186/s12902-022-01026-2 |
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