Assessing the proportion of patients with type 2 diabetes in tertiary care eligible for combination therapy with GLP-1 receptor agonist and SGLT2 inhibitors.

Abstract

Combination of GLP-1 receptor agonist (GLP-1 RA) and SGLT2 inhibitor (SGLT2i) is a recommended treatment in national and international diabetes guidelines, and the implementation is restricted by Swiss reimbursement standards. The implications for quality of care is partly dependent on the magnitude of patients affected. The aim was therefore to estimate the proportion of outpatients with type 2 diabetes in tertiary care that would be eligible for the combination therapy based on national treatment recommendations. Cross-sectional analysis of patients enrolled in SwissDiab at Kantonsspital St. Gallen with a visit in 2021 or later. Patients with a BMI ≥28 kg/m² and thus eligible for GLP-1 RA were identified, including patients prescribed GLP-1 RA with a BMI ≥28 kg/m² at treatment initiation. Of these, patients with heart failure, chronic kidney disease and/or insufficient glycaemic control were considered eligible for the addition of SGLT2i. Of 401 identified patients, 73.1% were eligible for GLP-1 RA. Of these, 61.1% had heart failure, chronic kidney disease and/or insufficient glycaemic control. The prevalence of heart failure was 25.7%, chronic kidney disease 77.7%, and insufficient glycaemic control 37.4%. Overall, 44.6% of the patients would stand to benefit from combination therapy. That almost half of the patients with type 2 diabetes in tertiary care were eligible for combination therapy with GLP-1 RA and SGLT2i highlight the potential negative impact of restricting access to evidence-based care central for the prevention of cardiorenal outcomes and premature death. The current study received unrestricted support from AstraZeneca.