American heart journalJan 8, 2025

Patterns of Type 2 Diabetes and Its Treatment in a Large, Diverse Healthcare System: Challenges and Opportunities for Following Guidelines

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jan 20, 2026

Abstract

Of the 147,338 patients with type 2 diabetes, 83% had an indication for SGLT2i or GLP-1 RA therapy based on guidelines.

Only 33% of all eligible patients received prescribed therapy for SGLT2i or GLP-1 RA.
Among those not receiving therapy, 49% had a 10-year atherosclerotic cardiovascular disease risk score of 10% or greater without known disease.
42% of patients eligible for therapy had established atherosclerotic cardiovascular disease.
52% had chronic kidney disease, while 14% had heart failure.
Despite high eligibility, the uptake of recommended therapies in this population remains low.

Simplified

BACKGROUND: The prevalence, chronicity and clinical impact of type 2 diabetes (T2D) defines this disease state as a critical determinant in morbidity and mortality, as encountered by individuals, health care systems, and public health in general. The need to understand and optimize T2D identification and management is now further heightened by the advent of medications with established cardiovascular (CV) and kidney benefits in such patients, namely sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA). Prescription rates for these agents have remained low despite guidelines incorporating and emphasizing their use. Better understanding T2D disease and management patterns, including percentage of patients meeting guideline indications, is necessary to address undertreatment, improve patient management, and enable better strategies. We evaluated such issues, including eligibility for and utilization of SGLT2i and GLP-1 RA, in a large health system caring for over 1.5 million patients annually.

METHODS: The electronic health record (EHR) at a large health network in the Northeastern United States was queried to identify patients 18 years of age or older with T2D and at least 1 hemoglobin A1c (HbA1c) between January 1, 2020 and January 1, 2023, examining those with T2D and 1) atherosclerotic CV disease (ASCVD), 2) an estimated 10-year ASCVD risk score ≥ 10% without known ASCVD, 3) heart failure (HF), and/or 4) chronic kidney disease (CKD) based on EHR listed comorbidities. Demographics, medications, comorbidities, and indications for SGLT2i and/or GLP-1 RA therapy were assessed by 1 or more of the 4 indications above as outlined in society guidelines.

RESULTS: Of the 147,338 patients who met inclusion criteria, 47% were female, 28% were non-white, and 14% with a non-English language preference. Of those, 121,508 (83%) had an indication for either SGLT2i or GLP-1 RA based on guideline recommendations: 17% were prescribed an SGLT2i, 22% were prescribed GLP-1 RA, and 6% of patients were prescribed both medications. Only 33% of all eligible patients were prescribed therapy. Of patients eligible for either an SGLT2i or GLP-1 RA therapy not currently receiving either therapy, 49% had 10-year ASCVD risk ≥ 10% without known ASCVD, 42% had ASCVD, 52% had CKD, and 14% had HF.

CONCLUSIONS: More than 4 out of 5 patients with T2D had a CV or kidney indication for either SGLT2i or GLP-1 RA. However, uptake of SGLT2i/GLP-1 RA in these high-risk populations remains low (just 32%) across this health network. Future studies are needed to identify better strategies to overcome provider, patient, and system-level barriers to the uptake and dissemination of guideline-concordant T2D therapies.

Full Text

Full text is available at the source.

View Full Text ↗

Funding

Competing interests

Declaration of competing interest Dr. Blood, Dr. Cannon, Dr. Plutzky, Daniel Gabovitch, and David Zelle report grant support from Boehringer Ingelheim, Better Therapeutics, Foresite Labs, Milestone Pharmaceutical, Eli Lilly, Novo Nordisk, and Pfizer. In addition, Dr. Blood reports grants from General Electric Health, and recieving personal fees from Alnylam, Milestone Therapeutics, NODE health, Walgreens Health, Medscape, Color Health, Corcept Therapeutics, Nference Inc, Withings, and Arsenal Capital Partners and holding equity in AIwithCare, Knownwell, Porter Health, and Signum Technologies. Dr. Chang reports grant support from Novo Nordisk and participating in clinical trials sponsored by Applied Therapeutics, AstraZeneca, Better Therapeutics, Boehringer Ingelheim, Eli Lilly, Fractyl Health, Novo Nordisk, Rhythm Pharmaceuticals, and Sanofi. Ms. Zacherle, Dr. Noone, and Dr. Robar are employees of Novo Nordisk Inc. Mr. Aronson reports personal fees from Nest Genomics and Harvard Medical School and holds equity in AIwithCare. Dr. Gaziano reports grant support from the NIH and Novartis and personal fees from Novartis, Multiply Labs, Amgen, DalCor, and Dimagi. Dr. Plutzky reports grant support from NIH/NIDDK, Boehringer Ingelheim, and Novartis and personal fees from Altimmune, Amgen, Bain Capital, Boehringer Ingelheim, Corcept, Esperion, Kailera, Merck, New Amsterdam, Novo Nordisk, and Toku Eyes. Dr. Cannon reports salary support from Colorado Prevention Center (CPC) Clinical Research which recieves research grant support from Amgen, Bayer, Cleerly, Esperion, Lexicon, and Silence and personal fees from Amryt/Chiesi, Amgen, Ascendia, Biogen, Boehringer Ingelheim, Bristol Meyers Squibb, CSL Bhering, Genomadix, Eli Lilly, Janssen, Lexicon, Milestone, Novartis, Pfizer, and Rhoshan and serving on the Data and Safety Monitoring Boards for the Areteia, Novo Nordisk, ROMTherapy Inc., and the Veterans Administration. Dr. Wexler serves on the Data Safety Monitoring Committee for Novo Nordisk's SOUL and FLOW trials. Dr. Scirica reports Amgen, Merck, Verve, and personal fees from AbbVie, AstraZeneca, Bayer, Hanmi, Lexeo, Novo Nordisk, Verve, and Boehringer Ingelheim and having equity in Health at Scale, Aboretun LifeScience, Doximity, and AIwithCare.

PubMed

Patterns of Type 2 Diabetes and Its Treatment in a Large, Diverse Healthcare System: Challenges and Opportunities for Following Guidelines

Abstract

Full Text

Funding

Competing interests

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the glp-1 therapies brief

Abstract

Full Text

Funding

Competing interests

Related papers

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the glp-1 therapies brief