The association between cardiology and diabetes clinic follow-up and GLP-1 Receptor agonist and SGLT2 inhibitor prescription in diabetic patients with cardiovascular disease

Background:
Patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) are at high risk of cardiovascular mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2-I) and glucagon-like peptide-1 receptor agonist (GLP-1RA) have been shown to reduce mortality in these patients. Nevertheless, these therapies remain underutilized in routine clinical practice. This study aimed to examine whether follow-up care in cardiology or diabetes clinics influences SGLT2-I and GLP-1RA prescription rates in diabetic patients with ASCVD.

Methods:
The CARdiovascular and DIAbetes (CARDIA)cohort includes patients with T2DM and ASCVD. Participant were stratified into four groups: (i) Patients followed by both cardiology and diabetes clinics; (ii) Patients followed by cardiology clinics only; (iii) Patients followed by diabetes clinics only and (iv)Patients not followed by either specialized clinic. The primary endpoints were prescription rates of SGLT2-I and GLP-1RA.

Results:
A total of 165,730 patients were included. Of these, 12% were followed by both cardiology and diabetes clinics, while 41% had no specialist follow-up. Patients under cardiology-only and diabetes-only follow-up accounted for 42% and 4.5%, respectively. Prescription rates of SGLT2-I and GLP-1RA were significantly higher in patients treated in specialized clinics. Dual therapy with both SGLT2-I and GLP-1RA was prescribed to 40% of patients treated in both cardiology and diabetes clinics compared to 12% of patients who were not referred to specialized clinics (p < 0.01). Conversely, lack of both SGLT2-I and GLP-1RA prescriptions was observed in 25% of patients followed in both cardiology and diabetes clinics compared to 66% of patients with no specialist follow-up (p < 0.01).

Conclusion:
Among diabetic patients with ASCVD, follow-up care in cardiology and diabetes clinics is associated with significantly higher prescription rates of both SGLT2-I and GLP-1RA. These findings highlight the importance of specialized care in improving adherence to guideline-based therapies.