Determinants of GLP-1 RA Use in Patients With ASCVD and Type 2 Diabetes

Several barriers and facilitators to the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with atherosclerotic cardiovascular disease (ASCVD) and concomitant type 2 diabetes (T2D) have been identified.  These findings were published in The American Journal of Cardiology.

An analysis used data from the nationwide Veterans Affairs (VA) administrative and clinical dataset. The researchers sought to evaluate the use of GLP-1 RAs among patients with ASCVD and T2D who had a primary care provider (PCP) visit between January 1, 2020, and December 31, 2020. The visits took place at 130 VA health care facilities, including VA medical centers and their associated outpatient community-based clinics. PCPs were defined as “both physician and nonphysician clinicians, including nurse practitioners and physician assistants.”

The study population included a total of 537,980 patients who had concomitant ASCVD and T2D. Overall, 2.4% of the patients were women, 70.8% were White, 15.3% were Black, and 8.0% were being treated with a GLP-1 RA. The mean patient age was 72.6±9.0 years.

Results of the study showed that, compared with nonusers of GLP-1 RAs, individuals who used GLP-1 RAs were significantly more likely to be White, were younger, had a higher burden of obesity (body mass index, ≥30), and had a lower burden of peripheral arterial disease in the absence of ischemic heart disease.

In contrast, users of GLP-1 RAs had a significantly higher burden of ischemic heart disease, hypertension, and systolic heart failure. Further, GLP-1 RA users were more likely to be receiving insulin, metformin, and sodium-glucose cotransporter 2 inhibitors. Users of GLP-1 RAs also reported a higher number of PCP visits and were more likely to have had an endocrinology clinic visit or a cardiology clinic visit in the 12 months prior to the index PCP visit (P <.01 for all).

Per multivariable-adjusted models, White race, obesity, hypertension, higher hemoglobin A_1c, ischemic heart disease, chronic kidney disease, and higher number of PCP visits and prior cardiology or endocrinology visits were all directly associated with the use of GLP-1RAs. Per the same models, patients with atherosclerosis and type 2 diabetes that were older, receiving care at a teaching facility, and had a physician PCP were all less likely to use GLP-1RAs.

A major limitation of the study is the fact that the investigators were unable to reliably evaluate and adjust for additional variables, including doses of respective antidiabetic medications, thus raising the possibility of residual confounding. Since data from a single health care system were used for the analysis, the results may not be applicable to other settings.

“Our data can help inform targeted interventions to promote equitable access to GLP-1 RA and incentivize the adoption of these disease-modifying agents in high-risk patient populations,” the study authors wrote.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Al Rifai M, Vaughan EM, Abushamat LA, et al. Correlates of glucagon-like peptide-1 receptor agonist use among patients with atherosclerotic cardiovascular disease and type 2 diabetes mellitus (from the Department of Veterans Affairs). Am J Cardiol. Published online March 16, 2022. doi:10.1016/j.amjcard.2022.02.013