GLP-1RA and SGLT2i utilization in people with type 2 diabetes with atherosclerotic cardiovascular disease (ASCVD) or at high risk of ASCVD in the Gulf Region

Abstract

OBJECTIVES To provide insights into the real-world usage of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) among individuals with type 2 diabetes (T2D) from Bahrain, Kuwait, and Qatar who either had established atherosclerotic cardiovascular disease (eASCVD) or were at high risk of developing ASCVD. METHODS This study of 1062 adults diagnosed with T2D from Bahrain, Kuwait, and Qatar is a sub-analysis within the Prevalence and Clinical Management of Atherosclerotic Cardiovascular Diseases in Patients with Type 2 Diabetes across Countries in the Middle East and Africa (PACT-MEA) study, a noninterventional, cross-sectional study. Participants were recruited from 13 primary or secondary care facilities between March and August 2022. Medical records of participants were reviewed to extract relevant data, including demographic characteristics, eASCVD status, ASCVD risk and glucose-lowering treatment. Appropriate descriptive and inferential statistical tests were performed. RESULTS Among T2D participants with eASCVD, a significantly higher proportion (41.3%) received SGLT2i compared to GLP-1RA (10.5%, p<0.001). There were notable variations in GLP-1RA/SGLT2i utilization across countries (p<0.001): being lowest in Bahrain (2.3%/18.0%), 26.9%/58.2% in Kuwait and 10.5%/67.1% in Qatar. The use of both medications was significantly higher in individuals with body mass index (BMI) ≥30 kg/m2 (p<0.05). CONCLUSION Despite these cardioprotective agents being recommended by guidelines, the study findings suggest a suboptimal use of GLP-1RA and SGLT2i in a real-world setting.