GLP-1RA/SGLT2i Dual Therapy for T2DM/ASCVD Linked to Younger Age, Heart Failure, Insulin Use
Background
Type 2 Diabetes Mellitus (T2DM) and Atherosclerotic Cardiovascular Disease (ASCVD) pose significant health burdens, with current treatments often failing to fully mitigate cardiovascular risk. Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) have independently demonstrated substantial cardiovascular benefits. Despite growing evidence suggesting additive benefits from dual therapy in high-risk populations, real-world data on the clinical factors driving combined GLP-1RA/SGLT2i prescription patterns remain limited, highlighting a gap in understanding optimal therapeutic strategies.
Study Design
This retrospective observational study analyzed 202 adults with T2DM and established ASCVD admitted to a tertiary care hospital. Patients were categorized based on their pre-admission outpatient regimen into four groups: neither therapy, GLP-1RA only, SGLT2i only, or combined GLP-1RA/SGLT2i therapy. Clinical characteristics and comorbidities were meticulously recorded at admission. Multinomial logistic regression analysis was then performed to identify specific clinical factors independently associated with the allocation to each treatment group.
Results
Among the 202 patients, 54.5% were not receiving either GLP-1RA or SGLT2i therapy. 10.9% were on GLP-1RA only, 21.3% on SGLT2i only, and only 13.4% were receiving combined therapy. > In adjusted analyses, combined GLP-1RA/SGLT2i therapy was independently associated with younger age (odds ratio [OR] 0.89 per year, 95% confidence interval [CI] 0.84-0.95, p < 0.001). Furthermore, the presence of heart failure significantly increased the likelihood of combined therapy (OR 9.64, 95% CI 2.65-35.04, p < 0.001), as did concurrent insulin use (OR 10.99, 95% CI 3.12-38.72, p < 0.001). Notably, chronic kidney disease and polyvascular disease were not found to be associated with dual therapy use in this cohort.
Why It Matters
This study highlights a significant gap in real-world clinical practice: over half of high-risk T2DM and ASCVD patients are not receiving guideline-recommended cardioprotective glucose-lowering therapies. Clinicians should consider that combined GLP-1RA/SGLT2i therapy is currently underutilized, especially in patients who could benefit. The association with younger age, heart failure, and insulin use suggests that current prescribing patterns may be driven by specific clinical presentations rather than a comprehensive assessment of overall cardiorenal risk. This implies a need for improved education and guideline adherence to ensure more patients with T2DM and ASCVD receive dual therapy, potentially leading to better long-term cardiovascular outcomes.