Rise in GLP-1 RA and SGLT2i Prescribing in Patients With T1D

TOPLINE:

Increases in prescriptions for both glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors were observed in patients with type 1 diabetes (T1D) from 2010 to 2023.

METHODOLOGY:

• GLP-1 RAs and SGLT2 inhibitors have significant benefits in cardiorenal protection and weight management; however, these medications are currently not approved for patients with T1D.
• Researchers conducted a pooled cross-sectional analysis using electronic health records (EHRs) from the Epic Cosmos database that covers more than half of US residents across 50 states to identify trends in prescribing GLP-1 RAs and SGLT2 inhibitors from 2010 to 2023 in the overall T1D population.
• A well-validated EHR-based algorithm was used to identify patients with T1D while removing duplicates.
• Demographic and clinical characteristics of the overall population with T1D in 2023 and those who were newly prescribed GLP-1 RAs or SGLT2 inhibitors were compared.

TAKEAWAY:

• Researchers identified 405,019 patients with T1D (mean age, 41.5 years; 49.5% women), of whom 18,725 were newly prescribed GLP-1 RAs and 7210 were newly prescribed SGLT2 inhibitors.
• The percentage of patients with T1D prescribed GLP-1 RAs increased from 0.3% in 2010 to 6.6% by 2023 and SGLT2 inhibitors increased from 0.1% to 2.4% over the same period.
• Overall, the percentage of patients with T1D who were prescribed either GLP-1 RAs or SGLT2 inhibitors significantly increased from 0.7% in 2010 to 8.3% in 2023 (P_trend
• Within the GLP-1 RA subclass, the prescription of semaglutide showed the most pronounced growth, increasing from 0.2% in 2018 to 4.4% in 2023.
• The highest increase in SGLT2 inhibitors prescribing was found in patients with T1D and cardiovascular disease, whereas the highest increase in GLP-1 RAs prescribing was found among those with obesity.

IN PRACTICE:

“Despite concerns that GLP-1 receptor agonists and SGLT2 inhibitors may cause serious adverse events such as ketoacidosis, the use of these medications in type 1 diabetes has sharply increased over the past decade. This increase is likely to continue due to their significant benefits in weight management and cardiorenal protection observed in individuals with type 2 diabetes and the general obese population,” said the corresponding author, Hui Shao, MD, PhD, of Emory University School of Medicine, Atlanta, in a news release.

SOURCE:

This study was led by Piaopiao Li, MS, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, and published online on October 23 in JAMA.

LIMITATIONS:

The study did not document the reasons for prescribing GLP-1 RAs and SGLT2 inhibitors to patients with T1D. Variations in prescribing across Epic participating health systems and the timing of their participation may have introduced bias in the trend analysis. Moreover, the algorithm used to identify patients with T1D may have misclassified certain patients.

DISCLOSURES:

This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. Some authors reported receiving grants or personal fees from Dexcom, Abbott, Bayer, and other sources. One author additionally reported serving as an associate editor for JAMA Network Open.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.