247-OR: Real-World Effectiveness of SGLT2 Inhibitors vs. GLP-1 Receptor Agonists in Patients With and Without Cardiovascular Disease

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 247-OR ◽  
Author(s):  
ELISABETTA PATORNO ◽  
AJINKYA PAWAR ◽  
SEBASTIAN SCHNEEWEISS ◽  
ROBERT J. GLYNN ◽  
DAE H. KIM ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Real World ◽  
Sglt2 Inhibitors ◽  
Receptor Agonists

409Cardiovascular risk profiles and outcomes in patients with type 2 diabetes - Implications for choice of new diabetes therapies

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M E Malik ◽  
C A Andersson ◽  
P B Blanche ◽  
C M R Rasmussen ◽  
B Z Zareini ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Ischemic Stroke ◽  
Sglt2 Inhibitors ◽  
Low Risk ◽  
Receptor Agonists ◽  
Risk Of Death ◽  
History Of ◽  
New Onset

Abstract Background Reflecting recent clinical trial findings, updated type 2 diabetes (T2D) guidelines recommend targeting SGLT2 inhibitors at patients at risk of heart failure (HF)-related events and GLP-1 receptor agonists at those at greater risk of atherosclerotic events. However, which cardiovascular disease phenotype in patients with T2D is more predictive of one or other type of these events is unclear. Purpose To estimate the risk of HF-related events and atherosclerotic events, according to background cardiovascular phenotype, in patients with T2D. Methods Patients with T2D and new-onset cardiovascular disease were identified using Danish health care registers (period 1995 to 2015). Patients were divided in four groups based on the primary type of cardiovascular disease: 1) HF, 2) ischemic heart disease (IHD), 3) ischemic stroke, and 4) peripheral artery disease (PAD). The absolute 5-year risks of the subsequent event, either a HF-related event or an atherosclerotic event (IHD, ischemic stroke and PAD), and the associated risk of death, were compared across the four groups. The Aalen-Johansen estimator was used to account for censoring, the competing risk of HF and atherosclerotic events, respectively, and death. Results We included 37,850 patients with T2D and new-onset cardiovascular disease. Median age was 70 years and 40% were female. Patients with HF were at higher risk of readmission for HF (18.1%; 95% confidence interval (CI): 17.2–19.0) than of an atherosclerotic event (14.2%; 13.4–15.0) (Figure). Patients with IHD were at higher risk of a new atherosclerotic event (23.5%; 22.8.-24.2) than of developing HF (9.3%; 8.9–9.8), although the risk of HF was still substantial. Conversely, patients with ischemic stroke were at low risk of HF (3.3%; 2.9–3.8) and higher risk of an atherosclerotic event (16.9%; 95% CI: 16.0–17.7). Patients with PAD had the lowest risk of HF (3.1%; 95% CI: 2.8–3.4) and the highest risk of an atherosclerotic event (35.0%; 95% CI: 33.4–36.7). Compared to a new atherosclerotic event, developing HF was associated with a higher 1-year risk of death (16.0%; 95% CI: 14.7–17.3 versus 33.0%; 95% CI: 31.8–34.2) amongst all patients. Cumulative incidence of first new event Conclusions In T2D, a patient's history of cardiovascular disease was predictive of type of subsequent cardiovascular event. While history of ischemic stroke and PAD were associated with a high risk of future atherosclerotic events, and low risk of HF, patients with IHD were at substantial risk of both types of event. Conversely, while history of HF was most predictive of future HF events, the risk of atherosclerotic events in patients with HF was also high. Our findings may help determine which type of therapy T2D patients with a particular cardiovascular disease history might benefit from – SGLT2 inhibitors, GLP-1 receptor agonists or potentially both. Acknowledgement/Funding Mariam Elmegaard Malik was funded by a research grant from Department of Cardiology, Herlev and Gentofte Hospital.

Abstract 14678: Prevalence Of Sglt2 Inhibitor And Glp-1 Receptor Agonist Prescriptions In Patients With Comorbid Diabetes And Cardiovascular Disease In An Integrated Academic Health System

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hawkins Gay ◽  
Jingzhi Yu ◽  
Lucia Petito ◽  
Tamara Isakova ◽  
Anand Srivastava ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Health System ◽  
Cardiovascular Events ◽  
Receptor Agonist ◽  
Sglt2 Inhibitor ◽  
Sglt2 Inhibitors ◽  
Prescribing Patterns ◽  
Academic Health ◽  
Receptor Agonists ◽  
Prescribing Trends

Introduction: Multiple randomized clinical trials have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP1) receptor agonists reduce the risk of cardiovascular events and mortality in patients with type 2 diabetes (T2D) and cardiovascular disease (CVD). In order to inform implementation strategies, we sought to describe prescribing trends among patients with T2D in clinical practice. Methods: We developed a clinical T2D cohort using a validated computable phenotype from the electronic data warehouse of a large academic health system among patients receiving care from January 1, 2013 through December 31, 2019. We retrospectively reviewed outpatient prescribing patterns in this cohort, and stratified results by CVD subtype (heart failure [HF] and atherosclerotic CVD [ASCVD]). Results: There were 23,485 patients identified with T2D. Mean (SD) age was 67 years (13), 46% were women, 61% were white, 32% had comorbid CVD (HF or ASCVD), and the mean (SD) hemoglobin A1c was 8.0% (5.7%). The majority of SGLT2 inhibitors and GLP1 receptor agonists were first prescribed by endocrinologists, 52% and 65% respectively. The prescription rate for both medication classes was low, and though SGLT2 inhibitor use increased over time (1% in 2013 to 14% in 2019; p<0.01), GLP1 receptor agonist use did not significantly change (10% in 2013 to 10% in 2019; p=0.93). Among patients with HF, SGLT2 inhibitor and GLP1 receptor agonist use increased annually by 42% and 7%, respectively, while patients with ASCVD experienced year over year growth of 63% and 13% in these categories. See Figure 1 (A and B) for more detail. Conclusions: Prescription rates of SGLT2 inhibitors and GLP1 receptor agonists remains low, especially for patients with T2D and CVD, despite a proven reduction in mortality and cardiovascular events. Strategies to increase the use of these proven medical therapies represent a major opportunity to improve outcomes in this high-risk group.

2350-PUB: Renoprotective Effects of SGLT2 Inhibitors in Japanese Real-World Clinical Practice

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 2350-PUB
Author(s):  
TAKAHIRO TOSAKI ◽  
SHIORI TOGA SATO ◽  
MASAKI KONDO ◽  
YUICHIRO YAMADA ◽  
AKEMI INAGAKI ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Real World ◽  
Sglt2 Inhibitors

scholarly journals Comparative Effectiveness of SGLT2 Inhibitors, GLP-1 Receptor Agonists, DPP-4 Inhibitors, and Sulfonylureas on Risk of Kidney Outcomes: Emulation of a Target Trial Using Health Care Databases

Diabetes Care ◽  
2020 ◽  
Vol 43 (11) ◽  
pp. 2859-2869 ◽  
Author(s):  
Yan Xie ◽  
Benjamin Bowe ◽  
Andrew K. Gibson ◽  
Janet B. McGill ◽  
Geetha Maddukuri ◽  
...  
Keyword(s):  
Health Care ◽  
Comparative Effectiveness ◽  
Sglt2 Inhibitors ◽  
Target Trial ◽  
Receptor Agonists

Abstract P162: Comparison Of The Clinical Effect Of Empagliflozin On Glycemic And Non-glycemic Parameters In Japanese Patients With Type 2 Diabetes And Cardiovascular Disease Treated With Or Without Baseline Metformin

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Atsushi Tanaka ◽  
Koichi Node
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Troponin I ◽  
Treatment Guidelines ◽  
Geometric Mean ◽  
Sglt2 Inhibitors ◽  
Hypoglycemic Agents ◽  
Clinical Parameters ◽  
Diabetes Status

Introduction: Recent treatment guidelines for type 2 diabetes (T2D) recommend sodium-glucose cotransporter 2 (SGLT2) inhibitors to be considered preferentially in patients with T2D at high cardiovascular risk or with cardiovascular disease (CVD), regardless of their diabetes status and prior use of metformin. Hypothesis: We assessed the hypothesis that the therapeutic impact of SGLT2 inhibitors on clinical parameters differs according to the use of metformin. Methods: This was a post hoc analysis of the Effect of Empagliflozin on Endothelial Function in Cardiovascular High Risk Diabetes Mellitus: Multi-Center Placebo-Controlled Double-Blind Randomized (EMBLEM) trial. All participants (n=105; women 31.4%; mean age 64.8 years) had both T2D and DVD and were randomized to either 24 weeks of empagliflozin 10mg daily or placebo. We assessed the effect of empagliflozin on changes from baseline to 24 weeks in glycemic and non-glycemic clinical parameters, according to the baseline use of metformin. Results: Overall, 53 (50.5%) patients received baseline metformin. In the 52 patients treated with empagliflozin (48.1% with baseline metformin), the change from baseline systolic blood pressure was greater in patients receiving metformin, compared to metformin-naïve patients (group difference -8.5 [95%CI -17.7 to 0.6 mmHg], p=0.066). Reduction in body mass index was significantly greater in patients receiving baseline metformin, relative to nonusers (-0.54 [95%CI -1.07 to -0.01] kg/m 2 , p=0.047). The group ratio (baseline metformin users vs. nonusers) of proportional changes in the geometric mean of high-sensitivity Troponin-I was 0.74 (95%CI 0.59 to 0.92, p=0.009). No obvious difference was observed in glycemic parameters, such as fasting plasma glucose and HbA1c, between the baseline metformin users and nonusers. Conclusions: Our findings suggest empagliflozin has a partially different impact on clinical parameters according to whether or not metformin has been used at baseline. As clinical opportunities for prescribing SGLT2 inhibitors are likely to increase, further research is needed to investigate the effect of SGLT2 inhibitors on clinical parameters taking into account the background situation of hypoglycemic agents, such as metformin.

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