Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs

Dhruv Mahtta; David J. Ramsey; Michelle T. Lee; Liang Chen; Mahmoud Al Rifai; Julia M. Akeroyd; Elizabeth M. Vaughan; Michael E. Matheny; Karla Rodrigues Do Espirito Santo; Sankar D. Navaneethan; Carl J. Lavie; Yochai Birnbaum; Christie M. Ballantyne; Laura A. Petersen; Salim S. Virani

doi:10.2337/dc21-1815

Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs

Dhruv Mahtta, David J. Ramsey, Michelle T. Lee, Liang Chen, Mahmoud Al Rifai, Julia M. Akeroyd, Elizabeth M. Vaughan, Michael E. Matheny, Karla Rodrigues Do Espirito Santo, Sankar D. Navaneethan, Carl J. Lavie, Yochai Birnbaum, Christie M. Ballantyne, Laura A. Petersen, Salim S. Virani

Research output: Contribution to journal › Article › peer-review

60 Citations (Scopus)

Abstract

OBJECTIVE There is mounting evidence regarding the cardiovascular benefits of sodium–glu-cose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use. RESEARCH DESIGN AND METHODS We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1 RA and the facility-level variation in their use. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1 RA in patients with ASCVD and T2DM. RESULTS Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received an SGLT2i while 8.0% of patients received a GLP-1 RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10th–90th percentile) facility-level rates were 14.92% (9.31–22.50) for SGLT2i and 10.88% (4.44–17.07) for GLP-1 RA. There was significant facility-level variation among SGLT2i use—MRR_unadjusted: 1.41 (95% CI 1.35–1.47) and MRR_adjusted: 1.55 (95% CI 1.46 –1.63). Similar facility-level variation was observed for use of GLP-1 RA—MRR_unadjusted: 1.34 (95% CI 1.29–1.38) and MRR_adjusted: 1.78 (95% CI 1.65–1.90). CONCLUSIONS Overall utilization rates of SGLT2i and GLP-1 RA among eligible patients are low, with significantly higher residual facility-level variation in the use of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients.

Original language	English
Pages (from-to)	372-380
Number of pages	9
Journal	Diabetes Care
Volume	45
Issue number	2
DOIs	https://doi.org/10.2337/dc21-1815
Publication status	Published - Feb 2022
Externally published	Yes

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Mahtta, D., Ramsey, D. J., Lee, M. T., Chen, L., Rifai, M. A., Akeroyd, J. M., Vaughan, E. M., Matheny, M. E., Do Espirito Santo, K. R., Navaneethan, S. D., Lavie, C. J., Birnbaum, Y., Ballantyne, C. M., Petersen, L. A., & Virani, S. S. (2022). Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs. Diabetes Care, 45(2), 372-380. https://doi.org/10.2337/dc21-1815

@article{b68c191a32a44507816d6da639a973a2,

title = "Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs",

abstract = "OBJECTIVE There is mounting evidence regarding the cardiovascular benefits of sodium–glu-cose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use. RESEARCH DESIGN AND METHODS We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1 RA and the facility-level variation in their use. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1 RA in patients with ASCVD and T2DM. RESULTS Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received an SGLT2i while 8.0% of patients received a GLP-1 RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10th–90th percentile) facility-level rates were 14.92% (9.31–22.50) for SGLT2i and 10.88% (4.44–17.07) for GLP-1 RA. There was significant facility-level variation among SGLT2i use—MRRunadjusted: 1.41 (95% CI 1.35–1.47) and MRRadjusted: 1.55 (95% CI 1.46 –1.63). Similar facility-level variation was observed for use of GLP-1 RA—MRRunadjusted: 1.34 (95% CI 1.29–1.38) and MRRadjusted: 1.78 (95% CI 1.65–1.90). CONCLUSIONS Overall utilization rates of SGLT2i and GLP-1 RA among eligible patients are low, with significantly higher residual facility-level variation in the use of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients.",

author = "Dhruv Mahtta and Ramsey, {David J.} and Lee, {Michelle T.} and Liang Chen and Rifai, {Mahmoud Al} and Akeroyd, {Julia M.} and Vaughan, {Elizabeth M.} and Matheny, {Michael E.} and {Do Espirito Santo}, {Karla Rodrigues} and Navaneethan, {Sankar D.} and Lavie, {Carl J.} and Yochai Birnbaum and Ballantyne, {Christie M.} and Petersen, {Laura A.} and Virani, {Salim S.}",

year = "2022",

month = feb,

doi = "10.2337/dc21-1815",

language = "English",

volume = "45",

pages = "372--380",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "2",

}

Mahtta, D, Ramsey, DJ, Lee, MT, Chen, L, Rifai, MA, Akeroyd, JM, Vaughan, EM, Matheny, ME, Do Espirito Santo, KR, Navaneethan, SD, Lavie, CJ, Birnbaum, Y, Ballantyne, CM, Petersen, LA & Virani, SS 2022, 'Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs', Diabetes Care, vol. 45, no. 2, pp. 372-380. https://doi.org/10.2337/dc21-1815

Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs. / Mahtta, Dhruv; Ramsey, David J.; Lee, Michelle T. et al.
In: Diabetes Care, Vol. 45, No. 2, 02.2022, p. 372-380.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes

T2 - Insights From the Department of Veterans Affairs

AU - Mahtta, Dhruv

AU - Ramsey, David J.

AU - Lee, Michelle T.

AU - Chen, Liang

AU - Rifai, Mahmoud Al

AU - Akeroyd, Julia M.

AU - Vaughan, Elizabeth M.

AU - Matheny, Michael E.

AU - Do Espirito Santo, Karla Rodrigues

AU - Navaneethan, Sankar D.

AU - Lavie, Carl J.

AU - Birnbaum, Yochai

AU - Ballantyne, Christie M.

AU - Petersen, Laura A.

AU - Virani, Salim S.

PY - 2022/2

Y1 - 2022/2

N2 - OBJECTIVE There is mounting evidence regarding the cardiovascular benefits of sodium–glu-cose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use. RESEARCH DESIGN AND METHODS We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1 RA and the facility-level variation in their use. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1 RA in patients with ASCVD and T2DM. RESULTS Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received an SGLT2i while 8.0% of patients received a GLP-1 RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10th–90th percentile) facility-level rates were 14.92% (9.31–22.50) for SGLT2i and 10.88% (4.44–17.07) for GLP-1 RA. There was significant facility-level variation among SGLT2i use—MRRunadjusted: 1.41 (95% CI 1.35–1.47) and MRRadjusted: 1.55 (95% CI 1.46 –1.63). Similar facility-level variation was observed for use of GLP-1 RA—MRRunadjusted: 1.34 (95% CI 1.29–1.38) and MRRadjusted: 1.78 (95% CI 1.65–1.90). CONCLUSIONS Overall utilization rates of SGLT2i and GLP-1 RA among eligible patients are low, with significantly higher residual facility-level variation in the use of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients.

AB - OBJECTIVE There is mounting evidence regarding the cardiovascular benefits of sodium–glu-cose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use. RESEARCH DESIGN AND METHODS We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1 RA and the facility-level variation in their use. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1 RA in patients with ASCVD and T2DM. RESULTS Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received an SGLT2i while 8.0% of patients received a GLP-1 RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10th–90th percentile) facility-level rates were 14.92% (9.31–22.50) for SGLT2i and 10.88% (4.44–17.07) for GLP-1 RA. There was significant facility-level variation among SGLT2i use—MRRunadjusted: 1.41 (95% CI 1.35–1.47) and MRRadjusted: 1.55 (95% CI 1.46 –1.63). Similar facility-level variation was observed for use of GLP-1 RA—MRRunadjusted: 1.34 (95% CI 1.29–1.38) and MRRadjusted: 1.78 (95% CI 1.65–1.90). CONCLUSIONS Overall utilization rates of SGLT2i and GLP-1 RA among eligible patients are low, with significantly higher residual facility-level variation in the use of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients.

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U2 - 10.2337/dc21-1815

DO - 10.2337/dc21-1815

M3 - Article

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AN - SCOPUS:85123249290

SN - 0149-5992

VL - 45

SP - 372

EP - 380

JO - Diabetes Care

JF - Diabetes Care

IS - 2

ER -

Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs

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