A recent study has revealed a notable rise in the prescriptions of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) for patients with type 1 diabetes (T1D) from 2010 to 2023, particularly among individuals at higher risk for cardiovascular and renal complications.
Conducted by researchers in the United States and published in JAMA Network Open, the study evaluated prescribing trends for these glucose-lowering medications in T1D patients, identifying a significant uptick in usage. Notably, patients with obesity showed a greater tendency to receive GLP-1RAs, while those with cardiovascular or renal conditions were more frequently prescribed SGLT2i.
Background
GLP-1RAs and SGLT2i are emerging classes of glucose-lowering medications known for their cardiovascular and renal benefits, as well as their ability to assist with weight management. Despite not being officially approved for T1D treatment, evidence suggests they are increasingly utilized in this patient population.
The study analyzed prescribing patterns for various GLP-1RAs—such as albiglutide, dulaglutide, semaglutide, exenatide, liraglutide, lixisenatide, and tirzepatide—and SGLT2i, including canagliflozin, empagliflozin, dapagliflozin, and ertugliflozin, within T1D patients.
Methodology
Using data from Epic Cosmos, a comprehensive electronic health record (EHR) database encompassing over 257 million U.S. residents, the research included 405,019 individuals with T1D. The average age of participants was 41.5 years, with a demographic breakdown showing 50.5% male and 70% identifying as non-Hispanic White. Among this population, 18,725 were newly prescribed GLP-1RAs, and 7,210 were prescribed SGLT2i.
Researchers identified T1D patients through a validated EHR algorithm and compared the characteristics of newly prescribed patients against the broader T1D cohort. The analysis considered various T1D subgroups, including those with obesity, cardiovascular disease, and chronic kidney disease.
Results and Discussion
The study found that prescriptions for GLP-1RAs and SGLT2i for T1D patients rose dramatically from 0.7% to 8.3% over the study period. Patients receiving SGLT2i exhibited a significantly higher incidence of cardiovascular issues (16.6% vs. 2.8%) and kidney disease (26.9% vs. 15.9%) compared to the overall T1D population. Conversely, those prescribed GLP-1RAs had a higher prevalence of obesity (69.4% vs. 45.7%).
The most significant increase within the GLP-1RA category was for semaglutide, which jumped from 0.2% in 2018 to 4.4% by 2023, while tirzepatide, introduced in 2022, accounted for 1.3% in its inaugural year. SGLT2i use surged among T1D patients with cardiovascular diseases, whereas GLP-1RAs were primarily utilized by those with obesity.
These findings underscore the growing off-label usage of these medications to address additional health risks in T1D patients. However, limitations exist, including a lack of insight into the rationale behind prescribing decisions, potential biases stemming from healthcare system differences, and challenges in accurately classifying T1D patients. The study’s generalizability may also be constrained by its reliance on a single EHR database.
Conclusion
The study indicates a marked increase in the prescription of GLP-1RAs and SGLT2i for individuals with T1D between 2010 and 2023, particularly for those exhibiting heightened cardiorenal risks. Despite the advantages these medications offer in terms of weight management and cardiovascular health, their use in T1D remains off-label, raising concerns regarding risks such as euglycemic diabetic ketoacidosis and excessive weight loss.
Further investigation is crucial to assess the safety and effectiveness of these therapies in the T1D population. The authors advise healthcare providers to remain vigilant when considering GLP-1RAs and SGLT2i for their T1D patients.
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