{"doi":"10.2337/dc21-1815","title":"Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs","abstract":"OBJECTIVE: There is mounting evidence regarding the cardiovascular benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use. RESEARCH DESIGN AND METHODS: We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1 RA and the facility-level variation in their use. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1 RA in patients with ASCVD and T2DM. RESULTS: Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received an SGLT2i while 8.0% of patients received a GLP-1 RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10th-90th percentile) facility-level rates were 14.92% (9.31-22.50) for SGLT2i and 10.88% (4.44-17.07) for GLP-1 RA. There was significant facility-level variation among SGLT2i use-MRRunadjusted: 1.41 (95% CI 1.35-1.47) and MRRadjusted: 1.55 (95% CI 1.46 -1.63). Similar facility-level variation was observed for use of GLP-1 RA-MRRunadjusted: 1.34 (95% CI 1.29-1.38) and MRRadjusted: 1.78 (95% CI 1.65-1.90). CONCLUSIONS: Overall utilization rates of SGLT2i and GLP-1 RA among eligible patients are low, with significantly higher residual facility-level variation in the use of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients.","journal":"Diabetes Care","year":2022,"id":233342,"datarank":6.539088979486052,"base_score":4.890349128221754,"endowment":4.890349128221754,"self_citation_contribution":0.7335523692332632,"citation_network_contribution":5.805536610252789,"self_endowment_contribution":0.7335523692332632,"citer_contribution":5.805536610252789,"corpus_percentile":null,"corpus_rank":null,"citation_count":132,"citer_count":100,"citers_with_citation_signal":88,"citers_with_endowment":88,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9483,"is_data_producer":true,"deposit_databanks":{"figshare":["10.2337/figshare.17052728"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":846321,"name":"David J. Ramsey","orcid":"0000-0002-5504-812X","position":1,"is_corresponding":false},{"id":231402,"name":"Michelle Lee","orcid":"0000-0003-3854-1294","position":2,"is_corresponding":false},{"id":231557,"name":"Liang Chen","orcid":"0000-0001-5845-2235","position":3,"is_corresponding":false},{"id":371434,"name":"Mahmoud Al Rifai","orcid":"0000-0002-6933-790X","position":4,"is_corresponding":false},{"id":847262,"name":"Julia M. Akeroyd","orcid":null,"position":5,"is_corresponding":false},{"id":430226,"name":"Elizabeth M. Vaughan","orcid":"0000-0001-9565-0134","position":6,"is_corresponding":false},{"id":11398,"name":"Michael E. Matheny","orcid":"0000-0003-3217-4147","position":7,"is_corresponding":false},{"id":847263,"name":"Karla Rodrigues do Espirito Santo","orcid":null,"position":8,"is_corresponding":false},{"id":236350,"name":"Sankar D. Navaneethan","orcid":"0000-0002-4953-7795","position":9,"is_corresponding":false},{"id":103408,"name":"Carl J. Lavie","orcid":"0000-0003-3906-1911","position":10,"is_corresponding":false},{"id":846322,"name":"Yochai Birnbaum","orcid":"0000-0001-7653-6328","position":11,"is_corresponding":false},{"id":233725,"name":"Christie M. Ballantyne","orcid":"0000-0002-6432-1730","position":12,"is_corresponding":false},{"id":695571,"name":"Laura A. Petersen","orcid":"0000-0003-0875-1231","position":13,"is_corresponding":false},{"id":74993,"name":"Salim S. Virani","orcid":"0000-0001-9541-6954","position":14,"is_corresponding":false},{"id":695567,"name":"Dhruv Mahtta","orcid":"0000-0003-3904-8872","position":0,"is_corresponding":true}],"reference_count":36,"raw_metadata":null,"created_at":"2026-07-19T00:21:25.223756Z","pmid":"35015080","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}