Aims: To assess treatment eligibility for, and received treatment with, sodium-glucose co-transporter 2 inhibitors (SGLT2) and glucagon-like peptide-1 (GLP-1) receptor agonists according to the 2019 the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) consensus report and the 2019 European Society of Cardiology (ESC) guidelines in a nationwide sample of patients with type 2 diabetes.
Methods and results: Both sets of guidelines included the treatment indications of heart failure, chronic kidney disease, and atherosclerotic cardiovascular disease while only the 2019 ESC guidelines also recommended treatment based on high or very high cardiovascular risk. The analyses included 435 000 patients with type 2 diabetes identified from the Swedish National Diabetes Register (2020-21). According to the 2019 ESC guidelines, 79.5% were recommended any of the two drugs (SGLT2 inhibitors: 37.2%; SGLT2 inhibitors or GLP-1 receptor agonists: 40.9%; GLP-1 receptor agonists: 1.4%). According to the 2019 ADA/EASD consensus report, 48.8% were recommended any of the two drugs (SGLT2 inhibitors: 37.2%; GLP-1 receptor agonists: 11.6%). Of those who had been recommended any of the two drugs, 33.7% had received the recommended treatment according to the 2019 ESC guidelines and 25.4% according to the 2019 ADA/EASD consensus report.
Conclusions: In this nationwide study, the proportion of patients with type 2 diabetes who were recommended treatment with an SGLT2 inhibitor or a GLP-1 receptor agonist was approximately 80% according to the 2019 ESC guidelines and around half according to the 2019 ADA/EASD consensus report. Uptake of these recommendations in routine clinical practice was limited.
Keywords: cardiovascular disease; chronic kidney disease; guideline uptake; guidelines; heart failure; treatment gaps.
We investigated the proportion of patients with type 2 diabetes in Sweden who were recommended treatment with two types of diabetes drugs, SGLT2 inhibitors, and GLP-1 receptor agonists, according to two European clinical guidelines. • Depending on the guideline used, between half and 80% of the patients with type 2 diabetes were recommended treatment with an SGLT2 inhibitor or a GLP-1 receptor. • Of those who had been recommended any of the two drugs, one in three or one in four, depending on the guideline used, had received the recommended treatment.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.