Comparative effectiveness of OW GLP-1 RAs and other glucose-lowering therapies among Medicare beneficiaries with T2D and ASCVD

Sep 11, 2025Diabetes research and clinical practice

Comparing weekly GLP-1 receptor agonists and other diabetes treatments in Medicare patients with type 2 diabetes and heart disease

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GLP-1 Therapies on OpenScience ↗PubMed ↗DOI ↗

Abstract

Among 398,470 Medicare beneficiaries, once-weekly glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were associated with a reduced risk of cardiovascular events compared to other non-insulin glucose lowering therapies.

Once-weekly GLP-1 RAs showed a hazard ratio range of 0.72 to 0.88 for cardiovascular events, indicating a lower risk compared to other treatments.
Patients treated with GLP-1 RAs experienced lower healthcare resource utilization, with a 9% reduction in total medical visits related to atherosclerotic cardiovascular disease.
Total medical costs were also reduced by 12% among those using GLP-1 RAs compared to other therapies.
Semaglutide, a specific GLP-1 RA, demonstrated the lowest risk of cardiovascular outcomes when compared to SGLT2 inhibitors and DPP-4 inhibitors.

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AIMS: To compare the incidence rates for cardiovascular (CV) outcomes and healthcare resource utilization (HCRU) and costs among patients treated with once-weekly (OW) glucagon-like peptide-1 receptor agonists (GLP-1 RAs) compared with other non-insulin glucose lowering therapies (ONIGLTs).

METHODS: This was an observational cohort study using Medicare fee-for-service claims data (2006-2022). Medicare beneficiaries with T2D and ASCVD treated with OW GLP-1 RAs or ONIGLTs were matched using propensity score matching.

RESULTS: Among the total 398,470 Medicare beneficiaries, OW GLP-1 RAs were associated with reduced risk of CV events (hazard ratios [HRs] range: 0.72 to 0.88, P < 0.05 for all) compared with ONIGLTs, in addition to lower HCRU and costs including ASCVD-related total medical visits (incidence rate ratio [95 % CI]: 0.91 [0.90-0.93]; P < 0.001) and total medical costs (mean cost ratio [95 %CI]: 0.88 [0.86-0.91]; P < 0.001). Among OW GLP-1 RAs, semaglutide had the lowest risk of all CV outcomes when compared with SGLT2is (HRs range: 0.80 to 0.85, P < 0.05 for all) and DPP-4is (HRs range: 0.58 to 0.73; P < 0.001 for all).

CONCLUSION: The study findings corroborate current guideline recommendations for GLP-1 RAs in people with T2D and ASCVD, and extend findings to lower HCRU and costs in a real-world setting, most notably for semaglutide.

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Comparative effectiveness of OW GLP-1 RAs and other glucose-lowering therapies among Medicare beneficiaries with T2D and ASCVD

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