Association of Prescription Co-payment With Adherence to Glucagon-Like Peptide-1 Receptor Agonist and Sodium-Glucose Cotransporter-2 Inhibitor Therapies in Patients With Heart Failure and Diabetes

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(6), P. e2316290 - e2316290

Published: June 1, 2023

Importance Type 2 diabetes (T2D) and heart failure (HF) prevalence are rising in the US. Although glucagon-like peptide-1 receptor agonists (GLP1-RA) sodium-glucose cotransporter inhibitors (SGLT2i) improve outcomes for these conditions, high out-of-pocket costs may be associated with reduced medication adherence. Objective To compare 1-year adherence to GLP1-RA SGLT2i therapies by prescription co-payment level individuals T2D and/or HF. Design, Setting, Participants This retrospective cohort study used deidentified data from Optum Insight’s Clinformatics Data Mart Database of enrollees commercial Medicare health insurance plans. Individuals aged 18 years or older HF who had a claim SLGT2i January 1, 2014, September 30, 2020, were included. Exposures Prescription co-payment, categorized as low (<$10), medium ($10 to<$50), (≥$50). Main Outcomes Measures The primary outcome was adherence, defined proportion days covered (PDC) 80% greater at 1 year. Logistic regression models examine association between adjusting patient demographics, medical comorbidities, socioeconomic factors. Results A total 94 610 (mean [SD] age, 61.8 [11.4] years; 51 226 [54.1%] male) prescribed therapy. Overall, 39 149 GLP1-RA, whom 25 557 (65.3%) PDC In fully adjusted models, (adjusted odds ratio [AOR], 0.62; 95% CI, 0.58-0.67) (AOR, 0.47; 0.44-0.51) less likely have compared those co-payment. 072 an SGLT2i, 37 339 (73.1%) 0.67; 0.63-0.72) 0.68; Conclusions Relevance this HF, highest among Improving guideline-based require interventions that reduce costs.

Language: Английский

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Predictors, Disparities, and Facility-Level Variation: SGLT2 Inhibitor Prescription Among US Veterans With CKD

American Journal of Kidney Diseases, Journal Year: 2023, Volume and Issue: 82(1), P. 53 - 62.e1

Published: Jan. 23, 2023

Language: Английский

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Implementation of chronic kidney disease guidelines for sodium-glucose co-transporter-2 inhibitor use in primary care in the UK: a cross-sectional study

EClinicalMedicine, Journal Year: 2024, Volume and Issue: 68, P. 102426 - 102426

Published: Jan. 21, 2024

The cardiovascular and kidney benefits of sodium-glucose co-transporter-2 (SGLT2) inhibitors in people with chronic disease (CKD) are well established. implementation updated SGLT2 inhibitor guidelines prescribing the real-world CKD population remains largely unknown.

Language: Английский

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Racial and Ethnic Disparities in Primary Prevention of Cardiovascular Disease

Canadian Journal of Cardiology, Journal Year: 2024, Volume and Issue: 40(6), P. 1016 - 1030

Published: Feb. 2, 2024

Cardiovascular disease (CVD) disproportionately affects ethnic-minority groups globally. Ethnic-minority face particularly high CVD burden and mortality, exacerbated by disparities across modifiable risk factors, wider determinants of health, limited access to preventative interventions. This narrative review summarizes evidence on such as physical activity, hypertension, diet, smoking, alcohol consumption, diabetes, the polypill for primary prevention in ethnic minorities. Across these we find inequities factor prevalence. The underscores that inequalities accessibility interventions treatments impede progress reducing using people. Although culturally tailored show promise, further research is required different factors. Social health structural also exacerbate people warrant greater attention. Additionally, only ethnicity-specific data guidelines are available most To address gaps research, provide recommendations include following: investigating sustainability real-world effectiveness sensitive interventions; ensuring peoples' perspectives considered research; longitudinal tracking factors; outcomes people; collection reporting ethnicity standardized.

Language: Английский

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Effect of iGlarLixi on continuous glucose monitoring—measured time in range in insulin‐naive adults with suboptimally controlled type 2 diabetes

Diabetes Obesity and Metabolism, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 4, 2025

People with type 2 diabetes (T2D) and glycated haemoglobin (HbA1c) ≥9% may benefit from fixed-ratio combination therapies such as iGlarLixi (insulin glargine 100 U/mL lixisenatide 33 μg/mL). Use of continuous glucose monitoring (CGM) is recommended, but data are lacking to assess the impact in individuals HbA1c ≥9%. Soli-CGM (NCT05114590) was a 16-week, multicentre, open-label study evaluating efficacy once-daily using blinded CGM-based metrics insulin-naive adults ≥9%-13% who were receiving ≥2 oral antihyperglycaemic agents (OADs) ± glucagon-like peptide-1 receptor agonists (GLP-1 RAs). The primary outcome change baseline week 16 percent time range (TIR; 70-180 mg/dL). Secondary outcomes included mean daily blood (BG), maximum postprandial 4 h post-breakfast (PPG-4 h), above (TAR; >180 On-treatment hypoglycaemia assessed. enrolled 124 participants (mean age, 55.6 years; HbA1c, 10.2%). Sixteen weeks treatment improved TIR (+26.2%), BG (-52.5 mg/dL), PPG-4 (-73.7 TAR (-28.7%); all p < 0.001. Rates American Diabetes Association level 1 (BG <70 ≥54 mg/dL) <54 reported 1.4 0.6 events per person-year, respectively. No 3 (requiring assistance) reported. In people T2D suboptimally controlled on OADs GLP-1 RAs, significantly reduced without severe hypoglycaemia.

Language: Английский

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Optimizing SGLT2 inhibitor and GLP-1 RA prescribing in high-risk patients with diabetes: a Department of Veterans Affairs quality improvement intervention

BMC Primary Care, Journal Year: 2025, Volume and Issue: 26(1)

Published: March 21, 2025

Abstract Introduction Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium glucose cotransporter-2 (SGLT2) inhibitors have dramatic clinical benefits, but many appropriate patients do not receive them. We developed a quality improvement (QI) intervention to increase the adoption of these drugs in with type 2 diabetes (T2D) atherosclerotic cardiovascular disease (ASCVD), chronic kidney (CKD), and/or heart failure (HF). The purpose this study was examine whether increased use SGLT2 GLP-1 RAs. Methods included: (1) education, academic detailing (1:1 pharmacist clinician coaching), audit feedback directed at providers allied health professionals Veterans Affairs Ann Arbor Healthcare System (VAAAHS); (2) outreach inreach T2D ASCVD, CKD, HF who were on RAs or baseline. Patients identified outcomes evaluated using existing VA national reports. performed difference-in-difference analysis change RA inhibitor prescribing rates before, during, after intervention, comparing VAAAHS same region (called Integrated Service Network (VISN)) nationally determine faster than VISN nationally. Results Home telehealth nurses pharmacy practitioners (CPPs) provided 445 patients; 48% ( n = 215) whom initiated Four CPPs 101 sessions 72 providers. Prior rate 22.7% VAAAHS, 20.3% 10 region, 18.7% At end 12-month had 37.9% 28.4% 26.5% Six-months post-intervention, continued 42.4% 32.2% 30.2% growth significantly p < 0.001). Conclusion Our multidisciplinary QI approximately 8% points average.

Language: Английский

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International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe

Journal of the American Heart Association, Journal Year: 2024, Volume and Issue: 13(9)

Published: April 30, 2024

Europe and North America are the 2 largest recipients of international migrants from low‐resource regions in world. Here, large differences cardiovascular disease (CVD) morbidity death exist between host populations. This review discusses CVD burden its most important contributors among migrant groups as well consequences migration to high‐income countries on diagnosis therapy. The available evidence indicates that generally have a higher risk compared with Cardiometabolic, behavioral, psychosocial factors their increased risk. However, despite these common denominators, there ethnic propensity develop relate pre‐ postmigration factors, such socioeconomic status, cultural lifestyle, stress, access health care usage. Some environmental may interact genetic (epigenetics) microbial which further influence limited number prospective cohorts clinical trials populations remains an culprit for better understanding pathophysiological mechanism driving developing ethnic‐specific prediction care. Only by improved complex interaction human biology, migration‐related sociocultural determinants influencing will we be able mitigate truly make inclusive personalized treatment possible.

Language: Английский

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Sociodemographic disparities in GLP-1RA and SGLT2i use among US adults with type 2 diabetes: NHANES 2005-March 2020

Current Medical Research and Opinion, Journal Year: 2024, Volume and Issue: 40(3), P. 377 - 383

Published: Jan. 9, 2024

Type 2 Diabetes (T2D) is a major cause of morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) sodium-glucose cotransporter-2 inhibitors (SGLT2i) are highly effective but underutilized. Our objective was to assess racial/ethnic other sociodemographic disparities in GLP-1RA/SGLT2i use among US adults with T2D.

Language: Английский

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Concordance With Screening and Treatment Guidelines for Chronic Kidney Disease in Type 2 Diabetes

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(6), P. e2418808 - e2418808

Published: June 26, 2024

Importance Chronic kidney disease (CKD) is an often-asymptomatic complication of type 2 diabetes (T2D) that requires annual screening to diagnose. Patient-level factors linked inadequate and treatment can inform implementation strategies facilitate guideline-recommended CKD care. Objective To identify risk for nonconcordance with in patients T2D. Design, Setting, Participants This retrospective cohort study was performed at 20 health care systems contributing data the US National Patient-Centered Clinical Research Network. evaluate concordance guidelines, adults outpatient clinician visit T2D diagnosis between January 1, 2015, December 31, 2020, without known were included. A separate analysis reviewed prescription angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) sodium-glucose cotransporter (SGLT2) (estimated glomerular filtration rate [eGFR] 30-90 mL/min/1.73 m urinary albumin-to-creatinine ratio [UACR] 200-5000 mg/g) October 2019, 2020. Data analyzed from July 8, 2022, through June 22, 2023. Exposures Demographics, lifestyle factors, comorbidities, medications, laboratory results. Main Outcomes Measures Screening required measurement creatinine levels UACR within 15 months index visit. Treatment reflected ACEIs ARBs SGLT2 12 before 6 following Results Concordance guidelines assessed 316 234 (median age, 59 [IQR, 50-67] years), whom 51.5% women; 21.7%, Black; 10.3%, Hispanic; 67.6%, White. Only 24.9% received screening, 56.5% 1 measurement, 18.6% neither. Hispanic ethnicity associated lack (relative [RR], 1.16 [95% CI, 1.14-1.18]). In contrast, heart failure, peripheral arterial disease, hypertension a lower nonconcordance. 4215 albuminuria, 3288 (78.0%) ACEI ARB; 194 (4.6%), inhibitor; 885 (21.0%), neither therapy. Peripheral eGFR treatment, while diuretic statin treatment. Conclusions Relevance this T2D, fewer than one-quarter recommended screening. 21.0% did not receive inhibitor ARB, despite compelling indications. may improve people

Language: Английский

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Utilization Rates of SGLT2 Inhibitors Among Patients With Type 2 Diabetes, Heart Failure, and Atherosclerotic Cardiovascular Disease

JACC Heart Failure, Journal Year: 2023, Volume and Issue: 11(8), P. 933 - 942

Published: May 17, 2023

Language: Английский

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