# Use of SGLT2 inhibitors and GLP-1 receptor agonists in patients with ischaemic heart disease and type 2 diabetes in Swedish primary care: a cross-sectional analysis of regional primary care registry data (QregPV)

## TL;DR

This study finds that SGLT2 inhibitors and GLP-1 receptor agonists are underused in Swedish patients with heart disease and diabetes, with notable differences by sex and healthcare center.

## Contribution

The study provides new insights into the real-world use of cardioprotective diabetes drugs in primary care, highlighting disparities and cost implications.

## Key findings

- SGLT2 inhibitors were prescribed to 37.2% of patients, more often to men than women.
- GLP-1 receptor agonists were prescribed to 10.0% of patients, with no sex difference.
- Prescription rates varied widely between healthcare centers, with higher costs for full implementation.

## Abstract

To assess the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with coexisting ischaemic heart disease (IHD) and type 2 diabetes (T2D) in primary care, in relation to European guidelines.

Cross-sectional observational study.

209 primary healthcare centres in Region Västra Götaland, Sweden (population 1.8 million in 2023).

14 414 patients with registered prevalent diagnoses of coexisting IHD and T2D, September 2023, in QregPV, the regional primary care quality of care register in Region Västra Götaland. Data on dispensed drugs were retrieved from the regional prescribed drug register, Digitalis.

The primary outcome was the proportion of patients with dispensed SGLT2i or GLP-1 RA in relation to sex, age and primary healthcare centres (including private vs public ownership). The secondary outcome was estimated additional prescription costs.

SGLT2i was dispensed to 37.2%, less often to women (adjusted OR (aOR) 0.64 (95% CI 0.59 to 0.70)). GLP-1 RA was dispensed to 10.0%, with no sex difference (aOR 1.04 (95% CI 0.92 to 1.18)). Use of SGLT2i and GLP-1 RA declined with age (p<0.001). Use across primary healthcare centres (95% central range) varied from 17.1% to 56.4% for SGLT2i and 0.0% to 23.4% for GLP-1 RA, without differences between private versus public primary healthcare centres (SGLT2i: aOR 0.95 (95% CI 0.85 to 1.06); GLP-1 RA: aOR 1.06 (95% CI 0.89 to 1.26)). Variation across primary healthcare centres was substantial (SGLT2i: adjusted median OR (aMOR) 1.29 (95% CI 1.23 to 1.36); GLP-1 RA: aMOR 1.48 (95% CI 1.37 to 1.62)). Treating all patients would increase the annual prescription costs, €3.9 million for SGLT2i and €10.4 million for GLP-1 RA.

SGLT2i and GLP-1 RA were underutilised in patients with coexisting IHD and T2D. The sex disparity in SGLT2i use warrants attention, as does the substantial variation between primary healthcare centres and the challenges of implementing costly cardioprotective therapies.