Persistence of Prescription Gaps of SGLT2i and GLP-1RA in Type 2 Diabetes and Cardiorenal Disease—A Current Global Perspective

Introduction and Objective: Large gaps persist in guideline-indicated prescription of cardiorenal protective medications (CRPM), namely SGLT2i and GLP-1RA, in people with T2D and cardiorenal disease, despite strong data and guidance for their use. Methods: We evaluated the treatment gap (Jan 2019-Dec 2024) in prescribing CRPM to people with T2D and cardiorenal disease using an EHR data aggregation initiative (Cosmos by Epic Systems) spanning 283 health systems across 49 US states and the Middle East. Eligible patients (N=7,800,815) had T2D and received care from either endocrinology, cardiology, nephrology, or primary care since 2019 (first guidelines with CRPM). Eligibility subgroups were defined using ADA 2022 Standards of Care. Current and past prescriptions for CRPM were extracted. Results: Eligibility subgroups included: ASCVD (N=2,367,381) - ‘SGLT2i or GLP1RA’; HF or CKD stage 3 (N=1,815,645) - ‘SGLT2i Only’; ASCVD and HF or CKD stage 3 (N=2,636,753) - ‘SGLT2i primary’; CKD stage 4/5 (N=981,022) - ‘GLP1RA Only’. The ever prescribed treatment gap ranged from 66.4% (SGLT2i primary) to 80.5% (GLP-1RA only) (Fig 1A). The treatment gap was higher for currently prescribed across all subgroups, ranging from 73.5% to 86.8% (Fig 1B). Conclusion: Current CRPM treatment gap is >73%, five years after the guidelines incorporated these recommendations for people with T2D. Disclosure: S. Agarwal: None. Y.A. ElNakieb: None. M.A. Basit: Advisory Panel; Pfizer Inc. M.E. Bowen: Research Support; Boehringer-Ingelheim. K. Marble: None. C. Mai: None. J. Pak: None. I. Lingvay: Consultant; Abbvie, Altimmune, Amgen, Alveus Tx, Antag Tx, Astra Zeneca, Bayer, Betagenon AB, Bioio Inc., Biomea, Boehringer-Ingelheim, Carmot, Cytoki Pharma, Eli Lilly, Intercept, Janssen/J&J, Juvena, Keros Ther, Novo Nordisk, Pharmaventures, Pfizer, Regeneron, Roche, Sanofi, Shionogi, Source Bio, Structure Therapeutics, TARGET RWE, TERNS Pharma, The Comm Group, WebMD, and Zealand Pharma. Research Support; Novo Nordisk, Sanofi, Boehringer-Ingelheim. Funding: This study was supported by BI. BI had no role in the design, analysis or interpretation of the results in this study. BI was given the opportunity to review the manuscript for medical and scientific accuracy as it relates to BI substances, as well as intellectual property considerations.