OBJECTIVE There is mounting evidence regarding the cardiovascular benefits of sodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use. RESEARCH DESIGN AND METHODS We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1 RA and the facility-level variation in their use. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1 RA in patients with ASCVD and T2DM. RESULTS Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received an SGLT2i while 8.0% of patients received a GLP-1 RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10th–90th percentile) facility-level rates were 14.92% (9.31–22.50) for SGLT2i and 10.88% (4.44–17.07) for GLP-1 RA. There was significant facility-level variation among SGLT2i use—MRRunadjusted: 1.41 (95% CI 1.35–1.47) and MRRadjusted: 1.55 (95% CI 1.46 –1.63). Similar facility-level variation was observed for use of GLP-1 RA—MRRunadjusted: 1.34 (95% CI 1.29–1.38) and MRRadjusted: 1.78 (95% CI 1.65–1.90). CONCLUSIONS Overall utilization rates of SGLT2i and GLP-1 RA among eligible patients are low, with significantly higher residual facility-level variation in the use of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients.

中文翻译：

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SGLT2 抑制剂和 GLP-1 受体激动剂的使用率及其在动脉粥样硬化性心血管疾病和 2 型糖尿病患者中的设施水平变化：来自退伍军人事务部的见解

目的 越来越多的证据表明钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i) 和胰高血糖素样肽 1 受体激动剂 (GLP-1 RA) 在动脉粥样硬化性心血管疾病 (ASCVD) 和 2 型糖尿病 (T2DM) 患者中的心血管益处. 评估这些药物类别的实际实践模式的数据很少。我们的目的是评估这些药物类别的利用率和设施级别的使用差异。研究设 在这些患者中，我们评估了 SGLT2i 和 GLP-1 RA 的使用以及它们使用的设施级差异。使用中位数比率（MRR）计算设施级别的变化，衡量两个随机机构在 ASCVD 和 T2DM 患者中使用 SGLT2i 和 GLP-1 RA 的可能性。结果 在 130 个 VA 设施的 537,980 名 ASCVD 和 T2DM 患者中，11.2% 的患者接受了 SGLT2i，而 8.0% 的患者接受了 GLP-1 RA。接受这些心脏保护性降糖药物治疗的患者平均年龄更小，非西班牙裔白人比例更高。总体而言，SGLT2i 和 GLP-1 RA 的中位数（第 10-90 个百分位数）设施水平率为 14.92%（9.31-22.50）和 10.88%（4.44-17.07）。SGLT2i 使用之间存在显着的设施级别差异——MRRunadjusted：1.41（95% CI 1.35–1.47）和 MRRadjusted：1.55（95% CI 1.46–1.63）。在使用 GLP-1 RA 时观察到类似的设施水平变化——MRRun 调整后：1.34（95% CI 1.29–1.38）和 MRR 调整​​后：1.78（95% CI 1.65–1.90）。结论 符合条件的患者中 SGLT2i 和 GLP-1 RA 的总体利用率较低，在这些药物类别的使用中残留设施水平的差异显着增加。我们的结果表明有机会优化它们的使用，以预防这些患者未来的不良心血管事件。