Regional and national trends in prescription of guideline directed cardio-kidney protective medications in people with type 2 diabetes and cardio-kidney disease

AIMS: Study the treatment gap of guideline-indicated therapies in people with T2D and atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF) or chronic kidney disease (CKD). METHODS: We extracted prescription history from 2005 to 2025 from a national dataset, a community-based health system, and an academic center. We assessed treatment gap (current and ever) within four subgroups defined using American Diabetes Association Standards of Care indications for SGLT2i and GLP-1RA use. RESULTS: We identified 6,951,624 people in the national dataset, 58,390 people at the community-based health system, and 15,235 people at the academic center. The current treatment gaps among people with ASCVD (without HF or CKD) were 72%, 67%, and 49%; with ASCVD and HF or CKD3 were 73%, 71%, and 55%; with CKD3 or HF without ASCVD were 75%, 71%, and 65%; with CKD4/5 were 87%, 89%, and 74% within the national dataset, community-based health system, and academic health system, respectively. The ever-prescription rates ranged from 23% to 39%, 30%-47%, 42%-64% within the national dataset, community-based health system, and academic center, respectively. DISCUSSION: Over half the population never received an indicated cardio-kidney protective prescription, and two-thirds lack a current prescription. These gaps were substantial across all systems; however, lowest at the academic center.