Gaps in Guideline-Indicated Prescribing of GLP1RA/SGLT2i in Patients with T2DM and Cardiorenal Disease according to ADA Standards of Care

We evaluated the treatment gap in prescribing guideline-directed therapies in patients with T2DM and cardiorenal disease using EHR data from a large academic medical center. Eligible patients had T2DM and an outpatient encounter after January 1, 2019 in either endocrinology, cardiology, nephrology, or primary care. Eligibility subgroups were defined using ADA 2022 Standards of Care: ASCVD (N=1,962) - ‘SGLT2i or GLP1RA’; HFrEF or HFpEF or CKD stage 3 (N=5,537) - ‘SGLT2i Only’; ASCVD and HF or CKD stage 3 (N=1,773) - ‘SGLT2i primary’; CKD stage 4/5 (N=1,547) - ‘GLP1RA Only’. We extracted prescriptions for any GLP1RA or SGLT2i since 2006 to characterize ever prescribed and currently prescribed. The treatment gap for patients (N=10,819) ever prescribed ranged from 45.5% for those who should have been prescribed either an SGLT2i or GLP1RA to 71.9% for those eligible for GLP1RA only (Panel A). The treatment gap was >20% higher for currently prescribed across all subgroups, ranging from 73.5% to 92.1% across the subgroups (Panel B). Large treatment gaps in prescribing of guideline-directed cardiorenal protective agents in high-risk patients with type 2 diabetes exist. While all subgroups were sub-optimally treated, those with CKD stage 4/5 had the largest gap. These findings will inform multi-faceted interventions geared to improve the care of such high-risk patients. Disclosure I.Lingvay: Advisory Panel; Novo Nordisk A/S, Lilly Diabetes, Boehringer-Ingelheim, Sanofi, Consultant; Carmot Therapeutics, Inc., Merck Sharp & Dohme Corp., Janssen Scientific Affairs, LLC, Pfizer Inc., Intercept, Intarcia, Valeritas, TargetRWE, Shionogi, Zealand Pharma, Structure, Bayer, Research Support; Novo Nordisk A/S, Boehringer-Ingelheim. M.E.Bowen: Research Support; Boehringer-Ingelheim. C.Mai: None. K.Marble: None. J.Pak: None. M.A.Basit: Research Support; Boehringer Ingelheim Inc., Verily Life Sciences. Funding Boehringer Ingelheim