The Association between Gender and GLP-1 Receptor Agonist and SGLT2 Inhibitor Prescription in Diabetic Patients with Cardiovascular Disease

Introduction: Patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) are at high risk of cardiovascular mortality. Treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2-I) and glucagon-like peptide-1 receptor agonists (GLP-1RA) has been shown to significantly reduce cardiovascular risk in these patients. However, these medications remain underutilized in routine clinical practice. This study aimed to investigate the prescription patterns of SGLT2-I and GLP-1RA by gender in diabetic patients with ASCVD.

Material and method: The CARdiovascular and DIAbetes (CARDIA) cohort includes patients with T2DM and ASCVD. Participants were stratified into two groups according to gender. The primary endpoints were prescription rates of SGLT2-I and GLP-1RA.

Results and discussion: The study cohort comprised 165,730 patients, of whom 41% were women. Prescription rates for SGLT2-Is and GLP-1RAs were significantly lower in women compared to men. Dual therapy with both SGLT2-Is and GLP-1RAs was prescribed to 19% of women and 26% of men (p < 0.01). Similarly, the absence of prescriptions for both medications was observed in 55% of women and 43% of men (p < 0.01). SGLT2-I monotherapy was prescribed to 15% of women and 25% of men (p < 0.01), while single-agent GLP-1RA therapy was prescribed to 9% of women and 6% of men (p < 0.01).

Conclusion: This large, real-world cohort study demonstrates that prescription rates for SGLT2-Is and GLP-1RAs remain suboptimal among diabetic patients with ASCVD, particularly in women. These findings underscore the need for targeted efforts to improve adherence to guideline-recommended therapies, especially among women, in order to optimize clinical outcomes in this high-risk population.