目的:胰高血糖素样肽-1受体激动剂(GLP-1RA)和钠-葡萄糖协同转运蛋白-2抑制剂(SGLT2i)在2型糖尿病(T2DM)患者中显示出独立于其降糖作用的心肾益处。在这项研究中,我们根据心肾事件的风险标准描述了符合接受和目前接受这些药物治疗的T2DM患者的比例.
方法:这项研究是对初级保健电子病历的横断面分析,在艾伯塔省南部,在2018年12月31日至2020年12月31日期间至少与初级保健提供者发生过1次接触的T2DM患者.进行了描述性和多变量逻辑回归分析,以检查被规定为新疗法之一的临床和人口统计学决定因素。
结果:我们的研究样本包括11,939名T2DM患者,其中66.3%的患者有使用SGLT2i或GLP-1RA的心肾指征.在二级和一级预防子样本中,19.4%和16.6%的人服用了SGLT2i或GLP-1RA,分别,与没有特定心肾适应症的20.0%相比。几个人层面的特征,如年龄(赔率比[OR],0.96;95%置信区间[CI],0.96至0.97),男性(或,1.37;95%CI,1.21至1.55)和糖化血红蛋白(OR,1.29;95%CI,1.24至1.34),与服用SGLT2i或GLP-1RA有关。
结论:SGLT2i或GLP-1类风湿性关节炎的使用率较低,且高风险和无心肾指征亚样本之间的差异极小,提示在初级保健环境中处方这些药物存在障碍。采取行动突出表明,并改善与代理人的接触,2型糖尿病患者在初级保健中获得更好的结果需要心肾获益.
OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (
SGLT2i) have shown cardiorenal benefits independent of their glucose-lowering effects among persons living with type 2 diabetes mellitus (T2DM). In this study, we describe the proportion of persons with T2DM eligible to receive and currently receiving these agents based on their risk criteria for cardiorenal events.
METHODS: This study was a cross-sectional analysis of primary care electronic medical records, in southern Alberta, of persons with T2DM who had at least 1 encounter with their primary care provider between December 31, 2018, to December 31, 2020. A descriptive and multivariate logistic regression analysis was conducted to examine clinical and demographic determinants of being prescribed one of the new treatments.
RESULTS: Our study sample included 11,939 persons living with T2DM, among whom 66.3% had a cardiorenal indication for
SGLT2i or GLP-1 RA use. In the secondary and primary prevention subsamples, 19.4% and 16.6% of persons were prescribed
SGLT2i or GLP-1 RA, respectively, compared with 20.0% of those with no specific cardiorenal indication. Several person-level characteristics, such as age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.96 to 0.97), male sex (OR, 1.37; 95% CI, 1.21 to 1.55) and glycated hemoglobin (OR, 1.29; 95% CI, 1.24 to 1.34), were associated with being prescribed
SGLT2i or GLP-1 RA.
CONCLUSIONS: Low rates of
SGLT2i or GLP-1 RA use and minimal differences between high-risk and no cardiorenal indication subsamples suggest the presence of barriers to prescribing these medications in a primary care setting. Action to highlight the indications for, and improve access to agents with, cardiorenal benefits will be required to achieve better outcomes for people with T2DM in primary care.