Initiation of SGLT2 inhibitors and GLP-1 receptor agonists according to level of frailty in people with type 2 diabetes and cardiovascular disease in Denmark: a cross-sectional, nationwide study

Malik, M. E. et al. (2023) Initiation of SGLT2 inhibitors and GLP-1 receptor agonists according to level of frailty in people with type 2 diabetes and cardiovascular disease in Denmark: a cross-sectional, nationwide study. Lancet Healthy Longevity, 4(10), e552-e560. (doi: 10.1016/S2666-7568(23)00164-2) (PMID:37734395)

Abstract

Background: Whether frailty influences the initiation of two cardioprotective diabetes drug therapies (ie, SGLT2 inhibitors and GLP-1 receptor agonists) in people with type 2 diabetes and cardiovascular disease is unknown. We aimed to assess rates of initiation of SGLT2 inhibitors and GLP-1 receptor agonists according to frailty in people with type 2 diabetes and cardiovascular disease. Methods: For this cross-sectional, nationwide study, all people with type 2 diabetes and cardiovascular disease in Denmark between Jan 1, 2015, and Dec 31, 2021, from six Danish health-data registers were identified. People younger than 40 years, with end-stage renal disease, with registered contraindications to SGLT2 inhibitors or GLP-1 receptor agonists, or with previous use of either drug therapy were excluded. The Hospital Frailty Risk Score was used to categorise people as either non-frail, moderately frail, or severely frail. Cox proportional hazards models were used to analyse the association between frailty and initiation of an SGLT2 inhibitor or a GLP-1 receptor agonist. Findings: Of 119 390 people with type 2 diabetes and cardiovascular disease, 103 790 were included. Median follow-up time was 4·5 years (IQR 2·7–6·1) and median age across the three frailty groups was 71 years (64–79). 65 959 (63·6%) of 103 790 people were male and 37 831 (36·5%) were female. At index date, 66 910 (64·5%) people were non-frail, 29 250 (28·2%) were moderately frail, and 7630 (7·4%) were severely frail. Frailty was associated with a significantly lower probability of initiating therapy with an SGLT2 inhibitor or a GLP-1 receptor agonist than in people who were non-frail (moderately frail hazard ratio 0·91, 95% CI 0·88–0·94, p<0·0001; severely frail 0·75, 0·70–0·80, p<0·0001). This association persisted after adjustment for age, sex, socioeconomic status, year of inclusion, duration of type 2 diabetes, duration of cardiovascular disease, polypharmacy, and comorbidity. Interpretation: In people with type 2 diabetes and cardiovascular disease in Denmark, frailty was associated with a significantly lower probability of SGLT2-inhibitor or GLP-1 receptor-agonist initiation, despite their benefits. Formulating clear and updated guidelines on the use of SGLT2 inhibitors and GLP-1 receptor agonists in people who are frail with type 2 diabetes and cardiovascular disease should be a priority. Funding: Department of Cardiology, Herlev and Gentofte University Hospital. Translation: For the Danish translation of the abstract see Supplementary Materials section.

• Item Type: Articles
• Additional Information: This study was funded by an unrestricted research grant from the Department of Cardiology, Herlev and Gentofte University Hospital (Copenhagen, Denmark).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Butt, Mr Jawad and Sattar, Professor Naveed and Kober, Professor Lars and McMurray, Professor John and Petrie, Professor Mark
• Authors: Malik, M. E., Butt, J. H., Strange, J. E., Falkentoft, A. C., Jensen, J., Andersson, C., Zahir, D., Fosbøl, E., Petrie, M. C., Sattar, N., McMurray, J. J.V., Køber, L., and Schou, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Lancet Healthy Longevity
• Publisher: Lancet Publishing Group
• ISSN: 2666-7568
• ISSN (Online): 2666-7568
• Published Online: 18 September 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Lancet Healthy Longevity 4(10):e552-e560
• Publisher Policy: Reproduced under a Creative Commons License