Association of Race and Ethnicity With Prescription of SGLT2 Inhibitors and GLP1 Receptor Agonists Among Patients With Type 2 Diabetes in the Veterans Health Administration System

JAMA, Journal Year: 2022, Volume and Issue: 328(9), P. 861 - 861

Published: Sept. 6, 2022

Importance Novel therapies for type 2 diabetes can reduce the risk of cardiovascular disease and chronic kidney progression. The equitability these agents’ prescription across racial ethnic groups has not been well-evaluated. Objective To investigate differences in sodium-glucose cotransporter-2 inhibitors (SGLT2i) glucagon-like peptide-1 receptor agonists (GLP-1 RA) among adult patients with by groups. Design, Setting, Participants Cross-sectional analysis data from US Veterans Health Administration’s Corporate Data Warehouse. sample included at least primary care clinic visits January 1, 2019, to December 31, 2020. Exposures Self-identified race self-identified ethnicity. Main Outcomes Measures outcomes were prevalent SGLT2i or GLP-1 RA prescription, defined as any active during study period. Results Among 1 197 914 (mean age, 68 years; 96% men; 1% American Indian Alaska Native, 2% Asian, Native Hawaiian, Other Pacific Islander, 20% Black African American, 71% White, 7% Hispanic Latino ethnicity), 10.7% 7.7% prescribed an a RA, respectively. Prescription rates respectively, 11% 8.4% patients; 11.8% 8% Islander 8.8% 6.1% 11.3% 8.2% White patients, 7.1% 7.8% non-Hispanic patients. After accounting patient- system-level factors, all had significantly lower odds compared lowest (adjusted ratio, 0.72 [95% CI, 0.71-0.74] 0.64 0.63-0.66] RA). Patients ethnicity (0.90 0.88-0.93] 0.88 0.85-0.91] Conclusions Relevance Administration system 2019 2020, medications low, individuals several different those statistically receiving prescriptions Further research is needed understand mechanisms underlying prescribing potential relationship clinical outcomes.

Language: Английский

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Prevalence and Overlap of Cardiac, Renal, and Metabolic Conditions in US Adults, 1999-2020

JAMA Cardiology, Journal Year: 2023, Volume and Issue: 8(11), P. 1050 - 1050

Published: Sept. 27, 2023

Individually, cardiac, renal, and metabolic (CRM) conditions are common leading causes of death, disability, health care-associated costs. However, the frequency with which CRM coexist has not been comprehensively characterized to date.

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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SGLT2 Inhibitor Use in Chronic Kidney Disease: Supporting Cardiovascular, Kidney, and Metabolic Health

Kidney Medicine, Journal Year: 2024, Volume and Issue: 6(8), P. 100851 - 100851

Published: June 13, 2024

Originally developed for use in type 2 diabetes mellitus (T2DM), sodium–glucose co-transporter-2 (SGLT2) inhibitors demonstrated diverse cardiovascular- and kidney-protective effects large outcome trials. Their subsequent approval as a treatment chronic kidney disease (CKD) marked pivotal shift the landscape of CKD management. Further to this, dapagliflozin empagliflozin patients with without T2DM afforded new opportunities this population. SGLT2 provide an effective favorable safety profile. However, their uptake has been slow, especially among T2DM, owing perhaps lack certainty familiarity healthcare professionals. As management continues evolve, professionals should remain knowledgeable about these changes, implement guideline recommendations promptly avoid therapeutic inertia. are recommended or foundational agents support cardiovascular, kidney, metabolic health. In review, we evidence-based answers questions that may be asked clinic regarding treat CKD.

Language: Английский

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Trends in use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in Australia in the era of increased evidence of their cardiovascular benefits (2014–2022)

European Journal of Clinical Pharmacology, Journal Year: 2023, Volume and Issue: 79(9), P. 1239 - 1248

Published: July 14, 2023

To investigate trends in SGLT2i and GLP-1RA use Australia the era of increased evidence their cardiovascular benefits.We used national dispensing claims for a 10% random sample Australians to estimate number prevalent new users (no prior year) or per month from January 2014 July 2022. We assessed prescriber specialty other antidiabetic medicines as proxy type 2 diabetes (T2D) conditions, respectively.We found large increase (216-fold SGLT2i; 11-fold GLP-1RA); 2022 approximately 250,000 were dispensed 120,000 GLP-1RA. Most had both T2D although onwards, one five did not have T2D. The proportion initiating by cardiologists after 2021, reaching 10.0% initiations Among with empagliflozin was most commonly prescribed SGLT2i, while dulaglutide semaglutide common GLP-1RA.SGLT2i is increasing Australia, particularly populations higher risk. among people without suggests that best-evidence are adopted across specialties, aligning expanding indications.

Language: Английский

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Safety of Sodium-Glucose Cotransporter-2 Inhibitors in Patients with CKD and Type 2 Diabetes: Population-Based US Cohort Study

Clinical Journal of the American Society of Nephrology, Journal Year: 2023, Volume and Issue: 18(5), P. 592 - 601

Published: Feb. 24, 2023

Background Limited information exists regarding the safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with CKD treated routine care. We evaluated SGLT2i and type 2 diabetes US practice. Methods Using claims data from Medicare two large commercial databases (April 2013–December 2021), we included 96,128 adults stages 3–4 who newly filled prescriptions for versus glucagon-like peptide-1 receptor agonists (GLP-1RA). Safety outcomes diabetic ketoacidosis (DKA), lower limb amputations, nonvertebral fractures, genital infections, hypovolemia, AKI, hypoglycemia, severe urinary tract infections (UTIs). Hazard ratios (HRs) incidence rate differences per 1000 person-years were estimated after 1:1 propensity score matching, adjusted >120 baseline characteristics. Results Compared GLP-1RA, initiators had a higher risk fractures (HR, 1.30 [95% confidence interval (CI), 1.03 to 1.65]; difference, 2.13 CI, 0.28 3.97]), amputations 1.65 1.22 2.23]; 2.46 1.00 3.92]), 3.08 2.73 3.48]; 41.26 37.06 45.46]). Similar risks DKA 1.07 0.74 1.54]; 0.29 −0.89 1.46]), hypovolemia 0.99 0.86 1.14]; 0.20 −2.85 3.25]), hypoglycemia 1.08 0.92 1.26]; 1.46 −1.31 4.23]), UTI 1.02 0.87 1.19]; 0.35 −2.51 3.21]) observed. AKI 0.93 0.99]; −6.75 −13.69 0.20]). Conclusions In receiving care, use was associated potentially fractures.

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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Prescription Patterns for Sodium-Glucose Cotransporter 2 Inhibitors in U.S. Health Systems

Journal of the American College of Cardiology, Journal Year: 2024, Volume and Issue: 84(8), P. 683 - 693

Published: Aug. 1, 2024

Language: Английский

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Prescription Patterns of Cardiovascular- and Kidney-Protective Therapies Among Patients With Type 2 Diabetes and Chronic Kidney Disease

Diabetes Care, Journal Year: 2022, Volume and Issue: 45(12), P. 2900 - 2906

Published: Sept. 23, 2022

To assess the prevalence and correlates of prescription sodium-glucose cotransporter 2 inhibitors (SGLT2i) and/or glucagon-like peptide 1 receptor agonists (GLP1-RA) in individuals with type diabetes mellitus (T2DM) without chronic kidney disease (CKD).This was a cross-sectional analyses SGLT2i GLP1-RA prescriptions from January 2019 to 31 December 2020 Veterans Health Administration System. The likelihood examined by presence or absence CKD predicted risks atherosclerotic cardiovascular (ASCVD) end-stage (ESKD).Of 1,197,880 adults T2DM, were prescribed 11% 8% patients overall, 12% 10% those concomitant CKD, respectively. In adjusted models, severe albuminuria less likely be versus nonalbuminuric odds ratios (ORs) 0.91 (95% CI 0.89, 0.93) 0.97 (0.94, 1.00), Patients 10-year ASCVD risk >20% (vs. <5%), had lower use (OR 0.66 [0.61, 0.71]) 0.55 [0.52, 0.59]). A 5-year ESKD >5%, compared <1%, associated 0.63 [0.59, 0.67]) but higher 1.53 [1.46, 1.61]).Among large cohort low CKD. We observed "risk-treatment paradox," whereby adverse outcomes receive these therapies.

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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