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New Diabetes Guidelines: Impact on Eligibility for Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Canada

Published:April 16, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.04.004

      Abstract

      Objectives

      Recent diabetes guidelines call for prescribing sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) for end-organ indications (cardiovascular disease [CVD], heart failure and chronic kidney disease) and for primary prevention of CVD in adults with multiple risk factors. Our aim was to assess the effect of new guidelines on the prevalence of SGLT2i/GLP-1RA–eligible adults, and their current rates of SGLT2i/GLP-1RA use.

      Methods

      A cross-sectional study was conducted of Canadian adults (age ≥18 years) with diabetes on June 30, 2020, using electronic medical record data from primary care practices in 5 provinces (Alberta, Manitoba, Newfoundland, Ontario and Québec). Indications were determined from comorbidities, lab values and cardiovascular risk factors.

      Results

      End-organ indications were present in 34.1% of adults for SGLT2i and in 17.1% for GLP-1RA (CVD only). Rates of SGLT2i and GLP-1RA use were only 14.0% and 4.3%, respectively, in those with end-organ indications. The majority of these individuals had glycated hemoglobin ≤7.0%. The combination of end-organ and primary prevention indications increased eligibility for SGLT2i to 62.6%, and for GLP-1RA to 59.1%.

      Conclusions

      The implications of this sizeable reclassification of adults as SGLT2i/GLP-1RA indicated on health-care budgets and cost-effectiveness requires further study. In the meantime, targeted efforts are necessary to improve SGLT2i/GLP-1RA use in those with end-organ indications that have robust evidence of cardiovascular and kidney benefit from newer agents.

      Résumé

      Objectifs

      Les récentes lignes directrices en matière de diabète préconisent de prescrire les inhibiteurs du cotransporteur sodium-glucose de type 2 (iSGLT-2) et les agonistes des récepteurs du GLP-1 (glucagon-like peptide-1, AR-GLP-1) lors d’indications d’atteintes aux organes cibles (maladie cardiovasculaire [MCV], insuffisance cardiaque et insuffisance rénale chronique) et de prévention primaire de MCV chez les adultes qui ont de multiples facteurs de risque. Notre objectif était d’évaluer les répercussions des nouvelles lignes directrices sur la proportion d’adultes admissibles aux iSGLT-2/AR-GLP-1, et leurs taux actuels d’utilisation des iSGLT-2/AR-GLP-1.

      Méthodes

      Il s’agissait d’une étude transversale auprès d’adultes canadiens (≥ 18 ans) diabétiques au 30 juin 2020 à partir des données des dossiers médicaux électroniques de cabinets en soins primaires de 5 provinces (Alberta, Manitoba, Terre-Neuve, Ontario et Québec). Les indications ont été déterminées à partir des maladies associées, des résultats de laboratoire et des facteurs de risque cardiovasculaire.

      Résultats

      Les iSGLT-2 étaient indiqués chez 34,1 % des adultes qui présentaient des atteintes aux organes cibles, et les AR-GLP-1, chez 17,1 % qui présentaient seulement une MCV. Les patients chez lesquels les iSGLT-2 et les AR-GLP-1 étaient indiqués dans le traitement des atteintes aux organes cibles, les taux d’utilisation étaient respectivement de 14,0 % et de 4,3 % seulement. La plupart de ces individus avaient une hémoglobine glyquée ≤ 7,0 %. La combinaison des indications d’atteintes aux organes cibles et de prévention primaire a fait accroître l’admissibilité aux iSGLT-2 à 62,6 % et aux AR-GLP-1 à 59,1 %.

      Conclusions

      Des études complémentaires sur les répercussions de cette importante reclassification des adultes admissibles aux iSGLT-2 et aux AR-GLP-1 sur les budgets et l’efficience en soins de santé sont nécessaires. Entre-temps, il faut tout mettre en œuvre pour améliorer l’utilisation des iSGLT-2/AR-GLP-1 lors d’atteintes aux organes cibles chez les individus qui satisfont aux indications, et qui démontrent des avantages cardiovasculaires et rénaux réels des nouveaux médicaments.

      Keywords

      Mots clés

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