There is a lack of information regarding the actual use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in modern community practice for patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD), despite recent national guidelines recommending these medications. The purpose of this study was to compare the effectiveness of SGLT2i against GLP-1 RA in treating people with T2D and ASCVD in a representative sample of US healthcare settings. Data from electronic health records were collected from January 2018 through March 2021 from 88 healthcare systems in the United States that were part of Cerner Real World Data. Adults with both ASCVD and T2D were excluded if they were on more than 1 glucose-lowering drug, had end-stage renal disease, or were in stage 5 of chronic kidney disease.

A total of 321,304 patients with T2D and ASCVD were found (130 280 women, or 40.5%; median [IQR] age, 70.9 [62.9-78.0] years), and they might be eligible for SGLT2i and/or GLP-1 RA. This group included 37,754 black people, or 11.8%; 51,522 Hispanic people, or 16.0%; and 256 008 white people, or 11.8%. From January 2018 to March 2021, the number of people using SGLT2i went up from 5.8% (11,285 of 194,264) to 12.9% (11,058 of 85,956), while the number of people using GLP-1 RA went up from 6.9% (13,402 of 194,264) to 13.8% (11,901 of 85,956), and the number of people using either agent went up from 11.4% (22,069 of 194,264) to 23.2% (19,909 of 85 Those who took an SGLT2i or GLP-1 RA were younger, had been hospitalized less often in the year before and were more likely to be taking other medications for secondary prevention.

The treated and untreated groups had comparable demographics regarding race, ethnicity, and use of primary care physicians and emergency rooms. More people used sulfonylureas and dipeptidyl peptidase 4 inhibitors in 2021 than those who took SGLT2i or GLP-1 RA. A small but significant rise in the use of SGLT2i and GLP-1 RA in adults with T2D and ASCVD was seen in response to guideline recommendations; however, fewer than a quarter of those with ASCVD and T2D getting pharmacological treatment were using either medication. To fully realize the population advantage that these medicines may provide, further work must be done to target those at the highest risk.