Impact of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA) in COVID-19 Patients with Preexisting Type 2 Diabetes (T2D) and Cardiovascular Disease (CVD)

Objective: CVD is the leading cause of death and disability among individuals with T2D. National guidelines recommend an SGLT2i or GLP-1 RA in patients with T2D who have or are at high risk for CVD. This study examined the impact of SGLT2i or GLP-1 RA on clinical outcomes in patients with pre-existing T2D+CVD who developed COVID-19. Methods: Adult patients with T2D+CVD who developed COVID-19 during 03/01/20-05/31/22 and had ≥1 year of health plan enrollment before the COVID-19 diagnosis were identified from the Healthcare Integrated Research Database (HIRD®). Eligible patients were classified as guideline concordant or not based on SGLT2i or GLP-1 RA prescription fills in the year before COVID-19 infection. COVID-19 related and all-cause hospitalization, ICU admission, and mortality were compared between SGLT2i or GLP-1 RA users and non-users. Propensity score (PS) matching and multivariable analyses were performed. Results: A total of 42,646 COVID-19 patients with T2D+CVD were identified with a mean follow-up of 8.6 months. The use of SGLT2i or GLP-1 RA was low (n=8,498; 20%). Patients receiving SGLT2i or GLP-1 RA were younger, had fewer comorbidities, took more CVD prevention medications, and were less likely to be hospitalized during the year before COVID-19 infection than non-users. After PS matching and multivariable adjustment, T2D+CVD patients with COVID-19 who received SGLT2i or GLP-1 RA were 12% less likely to be hospitalized and 10% less likely to be admitted to the ICU due to COVID-19 compared to those who did not (n=8,479 each group; both p<0.05). Reductions were also observed for all-cause hospitalization (6%), ICU admission (7%), and mortality (10%), but the results were not statistically significant. Conclusion: The findings suggest that SGLT2i and GLP-1 RA may improve outcomes in T2D+CVD patients with COVID-19 and support existing national guidelines. Disclosure C. Nguyen: Employee; HealthCore Inc. C. L. Crowe: Employee; HealthCore Inc. E. Kuti: Employee; Boehringer Ingelheim Inc. B. M. K. Donato: Employee; Boehringer Ingelheim Pharmaceuticals Inc. R. L. Djaraher: None. L. J. Seman: Employee; Boehringer Ingelheim Pharmaceuticals Inc. N. Graeter: None. T. P. Power: None. V. Willey: Other Relationship; Novo Nordisk A/S. Funding Boehringer Ingelheim