(VP089) REAL-WORLD USE OF GUIDELINE-DIRECTED CARDIOPROTECTIVE THERAPY IN TYPE 2 DIABETES MELLITUS WITH ATHEROSCLEROTIC CARDIOVASCULAR DISEASE: A RETROSPECTIVE COHORT ANALYSIS USING ADMINISTRATIVE HEALTH DATA

Background: Chronic hyperglycemia impacts various molecular mechanisms that lead to microvascular and macrovascular complications. Atherosclerotic cardiovascular disease (ASCVD) including stroke, is the largest cause of diabetes-related morbidity and mortality, with half of all deaths in people with type 2 diabetes (T2DM) being cardiovascular-related.

Recent clinical practices recommend anti-hyperglycemic agents such as glucagon-like peptide 1 receptor agonists (GLP1-RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT-2is) in treatment for people with T2DM and established ASCVD to reduce the risk of cardiovascular events. Meta-analyses have suggested that GLP1-RAs may reduce risk for stroke. In this study, we aimed to assess the real-world occurrence and treatment patterns of ASCVD overall in people with T2DM with a particular focus on stroke.

METHODS AND RESULTS: A retrospective cohort study was conducted using administrative health data from Alberta, Canada. The study cohort included patients with incident T2DM (from the Alberta Diabetes Chronic Disease Registry) between April 1, 2011 to March 31, 2022. ASCVD and stroke occurrence following diabetes between April 1, 2011 to March 31, 2021 were described. Treatment with GLP1-RAs and SGLT-2is was assessed in the most recent year (2021/22) in the subgroups of T2DM-ASCVD patients and T2DM-stroke patients.

There were 241,509 patients identified with T2DM in 2011-2022. The mean (standard deviation) age at diabetes index date was 57.3 (14.5) years and 43.6% (n=105,232) were female. The occurrence of ASCVD between 2011-2021 in the T2DM cohort was 19.2% (n=46,431), and the occurrence of stroke in the T2DM cohort was 3.5% (n=8,415), representing 18.1% of ASCVD cases. Following ASCVD, the proportion of patients dispensed GLP1-RAs and SGLT2is in 2021/22 was 7.5% (n=2,770) and 19.4% (n=7,172), respectively. Among patients with stroke, GLP1-RA and SGLT2i use following stroke was 5.2% (n=237) and 14.5% (n=660), respectively, in 2021/22.

Conclusion: Our study indicates that less than one fifth people with T2DM and ASCVD receive guideline-directed cardioprotective therapy with GLP-1RAs or SGLT2is, with even lower use in those who experienced a stroke, where SGLT2is were almost three times more likely to be used than GLP-1RAs. Efforts to increase the application of evidence-based care in clinical practice are required, to optimize cardiovascular outcomes for patients with T2D and ASCVD.