Variation in uptake of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor analogues in adults with type 2 diabetes at high cardiovascular risk

Abstract

Purpose: We quantified variation in the uptake of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor analogues (GLP-1RA) across sociodemographic, behavioural and clinical characteristics of people with type 2 diabetes (T2D) at high cardiovascular risk. Methods: We used the 45 and Up Study survey data (2018–2020) linked to dispensing and service claims for 10,171 people with T2D (56% male, median age of 72 years, median diabetes duration of 11 years). We calculated the prevalence of GLP-1RA and SGLT2i use within 1 year and used logistic regressions to assess associations with each participant characteristic. Results: We found that 2270 (22.3%) people with T2D used SGLT2i and 679 (6.7%) used GLP-1RA. Use of these medicines was higher in people diagnosed with diabetes for a longer period, a high number of comorbidities and survey year, decreased in older people, and varied by sex. After adjusting for these factors, utilisation of these medicines was lower among people who consume alcohol (versus non-drinkers) and higher among those with overweight or obesity. SGLT2i use was also higher in people who were less physically active or had established cardiovascular disease and lower in people with anxiety or depression. GLP-1RA use was higher among people with poorer health and lower in people born outside Australia/New Zealand. Conclusion: Prevalent use of SGLT2i and GLP-1RA was suboptimal and varied across clinical characteristics and behavioural risk factors. While some variation reflects complexities in prescribing for this older population, there remains opportunity for optimised prescribing within this high-risk population.