부산대학교 도서관

Introduction: Individuals with type 2 diabetes (T2D) are at increased risk for cardiovascular disease (CVD), the leading cause of mortality in these patients, and chronic kidney disease (CKD). Recent clinical guidelines recommend the use of diabetes pharmacotherapy with cardiovascular or renal benefits in patients with T2D and CVD or CKD.Aims: The aims of this study were to 1) assess the prevalence of established CVD, including atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF), and CKD, and 2) determine the proportion of patients prescribed CVD/CKD-protective diabetes pharmacotherapy (SGLT-2i and GLP1-RA) among individuals with T2D receiving primary care in the US.Data: Data for this retrospective, cross-sectional study were obtained from Optum Labs Data Warehouse, which contains de-identified administrative claims and electronic health record data representing a diversity of age, race, and ethnicity across the US. Eligible individuals were aged ≥18 years, had established T2D and were required to have ≥1 outpatient visit with a primary care provider in 2019.Results: This study included 843,119 individuals with T2D receiving care in 2019. Among these patients, the prevalence of CVD was 44.1%, with 41.5% having evidence of ASCVD and 14.4% having evidence of HF, and the prevalence of CKD was 34.6%. The prevalence of these comorbidities increased with age. For individuals who had T2D and ASCVD, HF, or CKD, 14.0%, 11.7% and 15.1%, respectively, were prescribed SGLT-2i or GLP1-RA, relative to 16.8% of patients with T2D without these comorbidities. Additionally, compared with younger patients, comorbid patients older than 65 years were prescribed these therapies at much lower rates.Conclusions: Among patients with T2D and established CVD, 9 of 10 patients had ASCVD: a 3-fold higher prevalence than HF. Less than 17% of individuals with T2D were prescribed a guideline-recommended glucose-lowering treatment with cardiovascular and renal benefits. The data from this study suggest that patients with T2D and CVD/CKD were prescribed less SGLT-2i or GLP1-RA compared to patients with T2D without these comorbidities. This trend was concerning among older patients, who had both higher rates of these comorbidities and lower prescribing trends.