In a recent study published within the American Heart Journal, researchers explore the efficacy of current approaches to scale back the danger of cardiovascular events in patients with type 2 diabetes (T2D).

Study: Contemporary Use of Cardiovascular Risk Reduction Strategies in Type 2 Diabetes. Insights from The Diabetes Collaborative Registry. Image Credit: siam.pukkato / Shutterstock.com

T2D and cardiovascular health

T2D patients are at an increased risk of hospitalization, decreased quality of life, and financial costs as a result of cardiovascular complications. These complications are liable for greater than 50% of deaths in T2D patients, with their incidence continuing to rise.

Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), each of which were developed to lower glucose levels, have been shown to enhance kidney and cardiovascular health, in addition to mortality rates, amongst high-risk T2D patients.

Concerning the study

In the current study, researchers analyze the trend of evidence-based therapies usage to lower cardiovascular risk in T2D patients over time. 

The study involved adult patients aged 18 years and above who had T2D and were prescribed a minimum of one glucose-lowering therapy from a listing of medication classes, including insulin, sulfonylurea, metformin, thiazolidinedione (TZD), GLP1RA, DPP-4i, and SGLT2i.

The study focused on several subgroups of patients, including those with heart failure (HF), atherosclerotic heart problems (ASCVD), and chronic kidney disease (CKD). Inside the ASCVD subgroup, patients had various conditions, similar to peripheral artery disease, coronary artery disease (CAD), and cerebrovascular disease. The cerebrovascular disease subgroup comprised patients with transient ischemic attack, prior stroke, and carotid artery intervention.

The researchers calculated a diabetes cardiovascular composite rating (DCCS) to find out the effectiveness of cardiovascular risk reduction techniques for individual patients. This rating indicated the proportion of medicines really useful to the patient for optimal cardiovascular risk reduction.

Five potential medications were evaluated for eligibility for a patient, including GLP-1RA, SGLT2i, statin, antithrombotic treatment, in addition to angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and angiotensin receptor neprilysin inhibitor (ARNI).

Results

A complete of 1,001,542 patients from 391 sites were included in the present study. The cohort had a median age of about 66 years and included 512,807 men.

Over 627,146 patients had a minimum of one high-risk condition, including documented ASCVD, heart failure, or CKD. More specifically, 518,270 patients had reported ASCVD, 177,518 noted an HF diagnosis, and 230,519 had CKD. As well as, the typical systolic blood pressure was almost 130 mmHg, whereas the typical body mass index (BMI) was roughly 33 kg/m2, and average hemoglobin A1C (HbA1C) was 7.4%.

Metformin was probably the most commonly prescribed glucose-lowering medication, with a usage rate of 73.1%. Insulin was utilized by 36.6% of patients, while 12.5% used SGLT2i and 12.9% used GLP-1RA.

The usage of SGLT2i or GLP-1RA amongst patients increased from 4.1% to twenty-eight.8% from 2013 to 2019. Nonetheless, DCCS decreased from 72% to 52% from 2013 to 2019 as a result of the rise in eligible medication options within the DCCS.

Roughly 18% of the 627,146 patients diagnosed with ASCVD, HF, or CKD got SGLT2i or GLP-1RA medication. Younger male patients without reported HF, ASCVD, or CKD who were prescribed insulin were more regularly prescribed SGLT2i medications. GLP-1RA drugs were regularly prescribed to younger patients, women, those without documented ASCVD or HF, and people taking insulin.

The male sex and an ASCVD diagnosis were related to a greater likelihood of using GLP-1RA or SGLT2i. Comparatively, those older or with an HF or CKD diagnosis were less prone to be prescribed these medications.

Older patients, men, those with certain medical conditions similar to ASCVD, CKD, or HF, and people on insulin exhibited higher DCCS. The hierarchical linear model revealed that the male sex and a CKD diagnosis were linked to higher DCCS, whereas an ASCVD or HF diagnosis correlated with lower DCCS.

Conclusions

The study findings revealed a positive trend within the utilization of glucose-lowering medications with respect to a discount in cardiovascular risk over time. Nonetheless, despite the potential advantages, the utilization of those agents is just not optimal, especially amongst patients with high-risk conditions.

The present study highlights the importance of training each cardiologists and patients concerning the additional advantages of therapies beyond glucose reduction. Educating healthcare providers on the benefits of SGLT2i and GLP-1RA medications, in addition to providing guidance on prescribing these agents and adopting team-based care models, can aid in changing the perception of those drugs from glucose-lowering agents to instruments for reducing cardiovascular risks in T2D patients.