Factors influencing the selection of an SGLT2i vs. a GLP-1RA as cardioprotective agent in patients with type 2 diabetes.

Purpose: Sodium glucose co-transporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated cardioprotective effects in people with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). In this patient group, there is treatment equipoise, from the standpoint of cardiovascular effect between these medication classes; however, factors associated with prescribing are poorly characterized.

Methods: We performed a retrospective real-world analysis by creating an electronic health record registry of people with type 2 diabetes and ASCVD (without additional indications for a specific cardioprotective class) who received a prescription for either an SGLT2i or GLP-1RA. We analyzed patient-, provider-, and clinical encounter-related predictors of being prescribed an SGLT2i or GLP-1RA using univariable and multivariable logistic regression analysis.

Results: A total of 573 eligible patients received either SGLT2i ( = 274) or GLP-1RA ( = 299) between January 2019 and October 2024. Care in cardiology (OR = 4.78; 95% CI, 2.53-9.04) strongly predicted SGLT2i prescription. Care in endocrinology (OR = 0.40; 95% CI, 0.23-0.68), higher BMI (OR = 0.92; 95% CI, 0.88-0.95, per BMI unit), and a higher recent estimated glomerular filtration (OR = 0.98; 95% CI, 0.96-0.99, per eGFR unit) predicted GLP-1RA prescription. The area under the receiver operating characteristic curve of the model was 0.78.

Conclusion: Prescriber's specialty strongly determined the selection of cardioprotective agents. Treatment guidelines should provide more specific guidance regarding patient selection and consider the holistic benefits of each drug class beyond their cardiovascular protective effects.