Most adults with type 2 diabetes and atherosclerotic cardiovascular disease are not receiving two key drug classes proven to protect the heart, with significant disparities linked to sex and insurance status highlighted in recent research.
Most adults with type 2 diabetes and established atherosclerotic cardiovascular disease are still not receiving two drug classes now widely recommended for cardiovascular protection, according to research published in the American Journal of Preventive Cardiology. In a retrospective review of electronic medical records from Houston Methodist’s Cardiovascular Learning Health System Registry, researchers found that just 22% of patients were prescribed an SGLT2 inhibitor and 25.3% were prescribed a GLP-1 receptor agonist.
The study covered 8,096 adults who had at least two outpatient visits between June 2016 and August 2023. The average age was 69.4 and 38.8% were women. By comparison, 85.6% were prescribed a statin and 78.1% received some form of glucose-lowering therapy, underscoring how much further uptake of these newer agents still has to go.
Sangeeta R. Kashyap of NewYork-Presbyterian/Weill Cornell Medical Centre said she was struck by how low the prescribing rates were, particularly at a tertiary care centre. Speaking to Healio, she said it was difficult to know whether cost, access, patient preference or clinician bias was driving the gap, but added that the drugs remain underused overall.
The study also pointed to differences by sex and patient profile. Women were less likely than men to be prescribed an SGLT2 inhibitor, but more likely to receive a GLP-1 receptor agonist for secondary prevention of cardiovascular disease. Patients given SGLT2 inhibitors were more often men, younger, privately insured and more likely to have chronic kidney disease or heart failure. Those prescribed GLP-1 drugs were also younger on average and more likely to have private insurance, higher body mass index and obesity.
Kashyap said the sex differences were especially noteworthy and warned against allowing bias to shape treatment decisions. She argued that clinicians should use these therapies based on cardiovascular risk rather than assuming they belong mainly in obesity care or in heart failure management. She also highlighted pharmacists as a practical way to help with medication titration, counselling and follow-up, saying they can ease the burden on busy practices.
Evidence from earlier studies points in the same direction. Research in the Veterans Affairs system found these medicines were underused and varied widely by facility, while studies published in Mayo Clinic Proceedings, Pharmaceuticals and JAMA Network Open have similarly reported low prescribing rates and disparities tied to age, insurance and comorbidity burden. Together, the findings suggest that guideline-backed therapies with proven cardiovascular benefits are still not reaching many of the patients most likely to benefit.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
