Abstract 4145147: Prescription of Sodium-glucose cotransporter-2 inhibitors and Glucagon-like peptide-1 receptor agonists among Veterans with diabetes and cardiovascular disease

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor (GLP-1) agonists (GLP-1a) improve cardiovascular (CV) health outcomes among individuals with type 2 diabetes and CV disease. US military Veterans have a higher prevalence of both diabetes and CV disease than the general population. Understanding what rates of SGLT2i and GLP-1a prescription are in this population is important for identifying strategies to improve CV outcomes. Methods: Using data from the Veterans Affairs Corporate Data Warehouse data, we identified all Veterans with type 2 diabetes and at least one of the following conditions – coronary artery disease, peripheral arterial disease, cerebrovascular disease/stroke, or congestive heart failure (either reduced or preserved ejection fraction). The study population was limited to people with active care with a primary care, cardiology, or endocrinology provider. We then examined trends in prescription of SGLT2i and GLP-1a from 2017 to 2022. Prescription rates among subgroups of gender and race were also evaluated. Differences between groups were compared using Chi-squared tests. Results: A total of 826,590 Veterans with both diabetes and CV disease were identified. Prescription rates of SGLT2i increased from 1.6% in 2017 to 22.3% in 2022 while GLP-1a rates increased from 2.0% to 12.0%. As of 2022, prescription rates of SGLT2i were similar between men and women (22.2% vs. 22.8%) while rates for GLP-1a were lower among men (11.8% vs. 18.6%, p<0.001). Among race subgroups, prescription rates were similar, but Black Veterans had the lowest rates for both categories of medications compared to white Veterans: 22.1% vs. 22.4%, p=0.03 for SGLT2i and 10.6% vs. 12.4%, p<0.001 for GLP-1a. Conclusions: Although prescription rates of SGLT2i or GLP-1a among Veterans with diabetes and CV disease have rose considerably between 2017 and 2022, as of 2022, a substantial proportion of Veterans with diabetes and CV disease were yet to be prescribed SGLT2i or GLP-1a. There also existed some disparities based on gender and race in prescription rates. Identifying, and removing, barriers towards prescribing these medications is crucial for improving the CV health of Veterans.