# Real-World Prescribing Patterns of SGLT2 Inhibitors and GLP-1 Receptor Agonists in Older Adults with Type 2 Diabetes and Cardiometabolic Disease

## TL;DR

This study examines how often older adults with type 2 diabetes and heart or kidney disease receive recommended diabetes medications in real-world settings.

## Contribution

The study identifies underutilization of SGLT2 inhibitors and GLP-1 receptor agonists in older adults due to underdiagnosis of comorbidities.

## Key findings

- Only 7.4% of older adults with type 2 diabetes received either SGLT2 inhibitors or GLP-1 receptor agonists.
- Just 1.6% of older adults were documented with ASCVD, heart failure, or CKD, suggesting underdiagnosis.
- Specialties outside cardiometabolic care prescribed these therapies in about 25% of cases.

## Abstract

Background/Objectives: Older adults with type 2 diabetes frequently have cardiovascular or kidney disease, and current guidelines strongly recommend the use of SGLT2 inhibitors or GLP-1 receptor agonists in these high-risk populations. This study aimed to critically evaluate their real-world utilization in a tertiary care setting to identify gaps in prescribing and opportunities for improvement. Methods: A retrospective cross-sectional analysis was conducted using electronic medical records from a tertiary academic hospital in Saudi Arabia (June 2019–May 2023). Patients aged ≥65 years with type 2 diabetes and documented ASCVD, heart failure, or CKD were classified as guideline-eligible. Prescribing rates, trends, specialty variation, and associated factors were assessed. Results: Among 223 older high-risk patients with type 2 diabetes, 83.4% received an SGLT2 inhibitor or GLP-1 receptor agonist. However, only 1.6% (223 out of 14,146 older adults) were identified in the electronic medical record as having ASCVD, heart failure, or CKD, suggesting potential underdiagnosis or incomplete recognition of guideline-eligible comorbidities. Overall, just 7.4% of older adults with type 2 diabetes were prescribed either therapy. Notably, approximately one-quarter of prescriptions originated from specialties not routinely involved in cardiometabolic care, indicating variability in prescribing patterns. Multivariable analysis showed that older age, female sex, and unmarried status were associated with lower odds of receiving therapy, while patients seen in cardiology or internal medicine had higher odds than those seen in primary care. Conclusions: Prescribing of GLP-1 receptor agonists and SGLT2 inhibitors was aligned with guideline recommendations in documented high-risk patients. Nevertheless, overall utilization remained low, indicating gaps in the recognition of cardiometabolic comorbidities. Enhancing routine cardiovascular and kidney risk assessment may improve therapy optimization.