Newer, more effective diabetes medications only reach a fraction of patients

Newer, more effective diabetes medications only reach a fraction of patients

A UCSF analysis has found that the newer generation of much more effective diabetes drugs reaches only a fraction of the patients recommended to take them based on new guidelines.

Type 2 diabetes (T2D), a condition in which the body cannot use insulin to clear sugar from the bloodstream, affects 1 in 10 Americans. It comes with serious health risks, including cardiovascular and kidney disease.

The study evaluated medications that patients received within a year of T2D diagnosis. During the period reviewed - 2014 to 2022 - groups such as the American Diabetes Association and the American Heart Association promoted the use of newer drugs over older, less effective ones.

The analysis, based on more than 40,000 records from the University of California Health Data House warehouse, found some encouraging results.

The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists—two newer categories of drugs—is increasing, particularly in patients with cardiovascular or renal disease.

Meanwhile, the use of sulfonylurea – a category of diabetes drugs with serious side effects that is now seen as a treatment of last resort – declined. And the use of metformin and insulin, the classic diabetes medications, decreased slightly.

By 2022, only 20% T2D patients received GLP-1 medications within a year of diagnosis, and fewer than 15% of patients received SGLT2 medications – reflecting a gap between professional guidelines and the care patients receive.

The researchers gave several reasons why this might be. One is that GLP-1 drugs like Wegovy and Ozempic are expensive and insurance doesn't always cover them. Another is that not every provider knows that leading organizations recommend prescribing GLP-1 and SGLT2 drugs such as Jardiance or Farxiga for T2D from the moment of diagnosis.

Some of the most devastating consequences of diabetes arise from its effects on the heart and kidneys, and fortunately we now have medications that target these effects. To maximize the benefits for the many hundreds of thousands of patients in the United States, we must increase access to these medications and ensure that clinicians understand how beneficial they are. “

Jonathan Watanabe, Pharmad, MS, PhD, senior author of the study

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