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Fig. 2 | Cardiovascular Diabetology

Fig. 2

From: Worldwide inertia to the use of cardiorenal protective glucose-lowering drugs (SGLT2i and GLP-1 RA) in high-risk patients with type 2 diabetes

Fig. 2

Most patients with T2D and CVD are not prescribed SGLT2i or GLP-1 RA. Data from the US and Denmark show clinical inertia in prescribing SGLT2i or GLP-1 RA, with only modest increases following the disclosures of the first CVOTs to show cardiorenal benefits, in September 2015 (EMPA-REG OUTCOME) and June 2016 (LEADER), respectively. Summaries are shown of data from the US Optum claims database between 2014 and 2018 [26, 31]; a rolling 3-year window study of clinical records from 20 US healthcare organisations, with the oldest cohort from Q1 2013 to Q1 2016 and the most recent cohort from Q1 2016 to 2019 [29, 30]; a nationwide cohort of new initiators of T2D therapies in Denmark from 2014 and 2017 [28]; and a nationwide registry of medicine utilisation in Denmark from 1996 to 2017, which did not include patient-level data [27]. Contemporary costs of SGLT2i, GLP-1 RA and DPP-4i in 2017, the most recent year captured by all the studies, show that pricing does not seem to explain therapy preferences. US prices are median National Average Drug Acquisition Cost reference data per day for empagliflozin, liraglutide and sitagliptin [73]. Other agents in each class were similarly priced. For Denmark, mean prices for a defined daily dose are shown across each class [27]

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