Diabetes Metab J.  2024 Mar;48(2):279-289. 10.4093/dmj.2023.0225.

Real-World Treatment Patterns according to Clinical Practice Guidelines in Patients with Type 2 Diabetes Mellitus and Established Cardiovascular Disease in Korea: Multicenter, Retrospective, Observational Study

• Yang YS
• Kim NH
• Baek JH
• Ko SH
• Son JW
• Lee SH
• Rhee SY
• Kim SK
• Sohn TS
• Jun JE
• Jeong IK
• Kim CH
• Song K
• Rhee EJ
• Noh J
• Hur KY
• Committee of Clinical Practice Guidelines, Korean Diabetes Association

• KMID: 2553598
• DOI: http://doi.org/10.4093/dmj.2023.0225

Abstract

Background
Recent diabetes management guidelines recommend that sodium-glucose cotransporter 2 inhibitors (SGLT2is) or glucagon-like peptide 1 receptor agonists (GLP-1RAs) with proven cardiovascular benefits should be prioritized for combination therapy in patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease (CVD). This study was aimed at evaluating SGLT2i or GLP-1RA usage rates and various related factors in patients with T2DM and established CVD.
Methods
We enrolled adults with T2DM aged ≥30 years who were hospitalized due to established CVD from January 2019 to May 2020 at 13 secondary and tertiary hospitals in Korea in this retrospective observational study.
Results
Overall, 2,050 patients were eligible for analysis among 2,107 enrolled patients. The mean patient age, diabetes duration, and glycosylated hemoglobin level were 70.0 years, 12.0 years, and 7.5%, respectively. During the mean follow-up duration of 9.7 months, 25.7% of the patients were prescribed SGLT2is after CVD events. However, only 1.8% were prescribed GLP-1RAs. Compared with SGLT2i non-users, SGLT2i users were more frequently male and obese. Furthermore, they had a shorter diabetes duration but showed worse glycemic control and better renal function at the time of the event. GLP-1RA users had a longer duration of diabetes and worse glycemic control at the time of the event than GLP-1RA non-users.
Conclusion
The SGLT2i or GLP-1RA prescription rates were suboptimal in patients with T2DM and established CVD. Sex, body mass index, diabetes duration, glycemic control, and renal function were associated with the use of these agents.

Keyword

Cardiovascular diseases; Diabetes mellitus, type 2; Guideline; Healthcare disparities

Figure

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  Fig. 1. Prescription rate of cardiovascular risk-lowering medications and antidiabetic medications at discharge after event in type 2 diabetes mellitus with established cardiovascular disease. The inset graph shows the number of class of antidiabetic medications. ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blockade; DPP4i, dipeptidyl peptidase 4 inhibitor; SGLT2i, sodium-glucose cotransporter 2 inhibitor; TZD, thiazolidinedione; AGI, alpha-glucosidase inhibitor; GLP-1RA, glucagon-like peptide 1 receptor agonist.

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  Fig. 2. Prescription rate of sodium-glucose cotransporter 2 inhibitor (SGLT2i) or glucagon-like peptide 1 receptor agonist (GLP1RA) in the patients with established cardiovascular disease during 9.7 months follow-up after events according to (A) cause of event and (B) department managing diabetes. IHD, ischemic heart disease; PAD, peripheral artery disease; HHF, hospitalization for heart failure.

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