PRESCRIBING PRACTICES OF CARDIOPROTECTIVE ANTI-DIABETIC MEDICATIONS IN MARGINALIZED PATIENTS

Abstract

Therapeutic Area: Diabetes Background: Cardiovascular disease is the most common cause of increased mortality in patients with type 2 diabetes mellitus (T2DM). Novel antidiabetic agents such as sodium-glucose co-transporter 2 inhibitors (SGLT-2) and glucagon-like peptide 1 agonists (GLP-1) were shown to reduce this risk. We aimed to evaluate prescription practices and racial differences of anti-diabetic cardioprotective medications in patients with HbA1c ≥9. Methods: A retrospective single center cohort study was conducted in a community-based, academic primary care clinic. The patient population was under-resourced and primarily Black. Inclusion criteria for the current study consisted of: age 18-75; T2DM and HbA1c ≥9; and seen within previous 18 months. Exclusions criteria included: type 1 DM; and patients under the care of an Endocrinologist. Variables of interest included patient demographics, associated comorbidities, and medications. Descriptive statistics (means, %) were used to summarize demographic and clinical variables. Chi-square analyses were used to compare differences between groups on categorical variables, and t-tests or ANOVAs were used to compare differences between groups on continuous variables. Results: Of the 1418 patients in the clinic population aged 18-75 with diabetes, 329 (23.2%) had an A1c greater than 9.0. Of these, 297 patients met the inclusion criteria. Patient were primarily Black (49.5%), female (54.5%), and over the age of 55 (60.3%). Patient clinical characteristics are summarized in Table 1. A significant difference in BMI between patients taking GLP1 (M = 34.1, SD = 8.2) and those not taking GLP1 [(M = 31.7, SD = 8.2); p = .016, d = 0.30] was identified. Furthermore, patients taking GLP1 were more likely to also be prescribed metformin than patients not taking GLP1 (72.0% vs 55.8%; OR = 2.04 [1.26 – 3.31]; p = .004). No statistical difference was seen in prescribing practices (e.g., GLP-1, SGLT2, or both) based on sex in heart failure (HF) and chronic kidney disease (CKD) patients. Conclusions: This study demonstrated underprescribing cardioprotective anti-diabetic drugs in patients with HF, CKD, and morbid obesity. Furthermore, there was no statistically significant difference in prescribing practices between races. We plan to conduct a quality improvement initiative to address barriers to optimal diabetes management.